Contents
The Georgia Living Will form serves as a crucial legal document that allows individuals to express their preferences regarding medical treatment in the event they become unable to communicate their wishes due to a terminal illness or irreversible condition. This form empowers individuals to outline specific healthcare decisions, including their desires about life-sustaining treatments, resuscitation efforts, and the use of artificial nutrition and hydration. By completing a Living Will, individuals can ensure that their healthcare providers and loved ones understand their wishes, thereby reducing the burden of decision-making during difficult times. It is essential to understand the various components of the form, such as the designation of an agent, the importance of witnessing, and the need for clear, concise language to avoid ambiguity. This document not only facilitates personal autonomy but also promotes peace of mind for both the individual and their family members, fostering an environment where healthcare choices align with personal values and beliefs.
Georgia Living Will Example
Georgia Living Will Template
This Living Will is designed in accordance with the Georgia Advance Directive for Health Care Act, ensuring that the wishes of the individual regarding medical treatment and life-sustaining measures are respected and followed when they are unable to communicate their decisions due to incapacitation.
Personal Information
Full Name: ___________________________________________________
Date of Birth: ________________________
Address: _____________________________________________________
City: _________________________ State: GA Zip Code: ___________
Phone Number: ____________________________
Email Address: ______________________________________________
Health Care Directive
I, ___________________________ (Full Name), born on _________________, hereby appoint the following person as my health care agent to make health care decisions on my behalf when I am unable to do so:
Health Care Agent Name: _______________________________________
Relationship: _________________________
Phone Number: ____________________________
Alternate Phone Number: ____________________
In the event that my above-named health care agent is unable, unwilling, or unavailable to act as my agent, I hereby appoint the following person as an alternate agent:
Alternate Agent Name: ________________________________________
Relationship: ________________________
Phone Number: ____________________________
Alternate Phone Number: _____________________
Living Will Instructions
I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choices I have marked below:
- The use of life-sustaining procedures if I am in a terminal condition
- The use of life-sustaining procedures if I am in a state of permanent unconsciousness
- The use of artificially administered nutrition and hydration
- Other wishes regarding my health care (specify): ______________________________________________________
These directions reflect my firm and settled commitment to decline medical treatment aimed at prolonging life if I am unable to make my own health care decisions and am either in a terminal condition or in a state of permanent unconsciousness.
Signature
My signature below indicates that I understand the nature and effect of this directive and that I am legally competent to make this directive.
Signature: _____________________________ Date: _________________
Print Name: ____________________________
Witness Declaration
This document must be signed in the presence of two witnesses, who also must sign the document, affirming that at the time the signer appeared to be of sound mind and free of duress or undue influence.
Witness 1: ___________________________________ Date: _________________
Witness 2: ___________________________________ Date: _________________
Notarization (Optional)
This Living Will was acknowledged before me on (date) __________________ by (name of principal) ________________________________.
____________________________ (Signature of Notarial Officer)
Seal:
Document Information
| Fact Name | Description |
|---|---|
| Purpose | A Georgia Living Will allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate their preferences. |
| Governing Law | The Georgia Living Will is governed by the Georgia Advance Directive for Health Care Act, O.C.G.A. § 31-32-1 et seq. |
| Eligibility | Any adult who is 18 years or older and of sound mind can create a Living Will in Georgia. |
| Witness Requirements | To be valid, a Living Will must be signed by the individual and witnessed by two individuals who are not related to the individual or entitled to any portion of their estate. |
| Revocation | A Living Will can be revoked at any time by the individual, provided that the revocation is communicated clearly to the healthcare provider. |
Fill out Other Common Templates for Georgia
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Georgia Auto Bill of Sale - It also gives peace of mind to both parties, knowing there is a legal record of the change in ownership.
State of Georgia Employee Handbook - It outlines the annual performance evaluation process, including goal setting, feedback, and the criteria for salary adjustments and bonuses.