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Free Alabama Directive Health Care PDF Template

The Alabama Directive Health Care form is a legal document that allows individuals to express their medical treatment preferences in the event they become unable to communicate their wishes. This form, which includes a living will and the option to designate a health care proxy, ensures that your desires regarding life-sustaining treatments and other medical decisions are respected. Understanding and completing this form can provide peace of mind for you and your loved ones during challenging times.

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Outline

The Alabama Directive Health Care form serves as a vital tool for individuals wishing to articulate their medical treatment preferences in advance, particularly in situations where they may become incapacitated. This form, often referred to as an advance directive, allows individuals to specify their desires regarding life-sustaining treatments, including the use of artificial food and hydration, in the event of terminal illness or permanent unconsciousness. Importantly, it empowers individuals to appoint a health care proxy, a trusted person who can make medical decisions on their behalf if they are unable to communicate their wishes. The form emphasizes that individuals can modify or revoke their directives at any time, ensuring that their current values and preferences are honored. Additionally, it requires the signatures of witnesses to validate the document, reinforcing the importance of informed consent and legal recognition in health care decisions. By utilizing this form, individuals can take proactive steps to ensure that their health care aligns with their personal beliefs and desires, alleviating the burden on loved ones during challenging times.

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Documents used along the form

The Alabama Directive Health Care form is an essential document that allows individuals to express their medical treatment preferences when they can no longer communicate. Alongside this form, several other documents are commonly utilized to ensure that a person's health care wishes are honored. Below is a list of these documents, each accompanied by a brief description.

Durable Power of Attorney for Health Care: This document designates a specific individual to make medical decisions on your behalf if you are unable to do so. It is broader than the health care proxy designation, allowing the appointed person to act in various medical situations.
Do Not Resuscitate (DNR) Order: A DNR order instructs medical personnel not to perform cardiopulmonary resuscitation (CPR) if your heart stops or if you stop breathing. This document is crucial for individuals who wish to avoid aggressive resuscitation efforts.
Living Will: Similar to the Alabama Directive Health Care form, a living will outlines specific medical treatments you would or would not want in situations where you cannot express your wishes. It is often used to guide health care providers and loved ones.
Articles of Incorporation: This vital document establishes a corporation in New York and lays out its essential details, including the name and purpose. For more information, you can visit https://nydocuments.com/articles-of-incorporation-form.
Organ Donation Consent Form: This form allows individuals to express their wishes regarding organ donation after death. It can help relieve family members from making difficult decisions during a time of grief.
Health Care Proxy Appointment: This document specifically appoints someone to make health care decisions for you, ensuring that your medical preferences are respected when you cannot advocate for yourself.
Advance Care Plan: An advance care plan is a comprehensive document that includes your health care preferences, values, and goals. It serves as a guide for family and health care providers in making decisions that align with your wishes.
Patient Advocate Designation: This document designates a patient advocate who can speak on your behalf in medical situations. Unlike a health care proxy, this role may focus more on communication and advocacy rather than decision-making.
Medical History Form: This form provides health care providers with essential information about your medical history, medications, allergies, and past treatments. It can aid in making informed decisions about your care.
Medication Directive: This document outlines specific preferences regarding medication management, including any medications you wish to avoid or prefer to receive. It helps ensure that your treatment aligns with your values.

Each of these documents plays a critical role in health care planning. Ensuring that they are in place can provide peace of mind for both you and your loved ones, knowing that your wishes will be respected during challenging times.

Steps to Filling Out Alabama Directive Health Care

Completing the Alabama Directive Health Care form is an important step in ensuring your medical wishes are known and respected. This form allows you to communicate your preferences regarding medical treatment and appoint a health care proxy if desired. Follow these steps carefully to fill out the form correctly.

Start with Section 1, titled "Living Will." Write your full name and confirm that you are at least 19 years old and of sound mind.
Indicate your wishes regarding life-sustaining treatment if you become terminally ill or injured. Initial next to "yes" or "no" for whether you want life-sustaining treatment.
Next, indicate your wishes regarding artificially provided food and hydration. Initial next to "yes" or "no" for whether you want food and water provided through a tube or IV if terminally ill or injured.
In the same section, indicate your wishes if you become permanently unconscious. Again, initial next to "yes" or "no" for life-sustaining treatment.
Indicate your wishes for artificially provided food and hydration if you become permanently unconscious. Initial next to "yes" or "no."
List any other specific directions you may have. If you do not have additional directions, initial the designated space.
Move to Section 2 to decide if you want to name a health care proxy. Initial next to your choice: either to not name a proxy or to name one.
If you choose to name a proxy, fill in the required information, including their name, relationship, address, and phone numbers.
Indicate whether you want your health care proxy to make decisions about food and hydration through a tube or IV by initialing "yes" or "no."
Decide how you want your health care proxy to follow your directions. Initial next to one of the three options provided.
Proceed to Section 3 and acknowledge your understanding of the conditions listed. No action is required here, just read and confirm.
In Section 4, provide your name, date of birth, and sign the form with the date you signed it.
In Section 5, find two witnesses who meet the criteria. Have them fill in their names, sign the form, and date it.
Finally, in Section 6, if you have named a health care proxy, they must sign and date the form, along with the second choice for proxy if applicable.

Misconceptions

Understanding the Alabama Directive Health Care form is essential for making informed decisions about medical care. However, several misconceptions exist regarding this important document. Below is a list of common misconceptions and clarifications for each.

Misconception 1: You must have an advance directive.

This is not true. While having an advance directive is beneficial, it is not a legal requirement in Alabama.

Misconception 2: The form is only for terminal illnesses.

The form can be used for various medical situations, including permanent unconsciousness, not just terminal conditions.

Misconception 3: Once signed, the directives cannot be changed.

You can change your mind at any time. Simply tear up the old form and create a new one to reflect your updated wishes.

Misconception 4: You cannot receive comfort care if you refuse life-sustaining treatment.

Even if you choose not to receive life-sustaining treatment, you will still receive medications and treatments to ease pain and ensure comfort.

Misconception 5: You must name a health care proxy for the directives to be followed.

Naming a health care proxy is optional. The directives will still be honored even if you choose not to appoint someone.

Misconception 6: The health care proxy can make any decision without limitations.

You can specify the extent of authority your health care proxy has in your directives, including whether they can make decisions beyond what is listed in the form.

Misconception 7: Witnesses must be family members.

This is incorrect. Witnesses cannot be related to you by blood, adoption, or marriage, ensuring impartiality in the witnessing process.

Misconception 8: The form is valid only if signed in front of a notary.

In Alabama, the form requires two witnesses, not a notary, to be legally valid. Ensure your witnesses meet the criteria outlined in the form.

Being aware of these misconceptions can help individuals make better decisions regarding their health care preferences. It's important to understand the rights and options available when completing the Alabama Directive Health Care form.

Form Sample

AD V AN CE D I RECTI V E FOR H EALTH CARE

( Liv in g W ill a n d H e a lt h Ca r e Pr ox y )

This form may be used in the State of Alabama to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. You are not required to have an advance directive. If you do have an advance directive, be sure that your doctor, family, and friends know you have one and know where it is located.

Se ct ion 1 . Livin g W ill

I, ___________________, being of sound mind and at least 19 years old, would like to make the

following wishes known. I direct that my family, my doctors and health care workers, and all others follow the directions I am writing down. I know that at any time I can change my mind about these directions by tearing up this form and writing a new one. I can also do away with these directions by tearing them up and by telling someone at least 19 years of age of my wishes and asking him or her to write them down.

I understand that these directions will only be used if I am not able to speak for myself.

I f I be com e t e r m in a lly ill or in j u r e d:

Terminally ill or injured is when my doctor and another doctor decide that I have a condition that cannot be cured and that I will likely die in the near future from this condition.

Life sustaining treatment – Life sustaining treatment includes drugs, machines, or medical procedures that would keep me alive but would not cure me. I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable.

Place your initials by either “yes” or “no”:

I want to have life sustaining treatment if I am terminally ill or injured. ____ Yes ____ No

Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I am terminally ill or injured I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.

Place your initials by either “yes” or “no”:

I want to have food and water provided through a tube or an IV if I am terminally ill or injured.

____ Yes ____ No

I f I Be com e Pe r m a n e n t ly U n con sciou s:

Permanent unconsciousness is when my doctor and another doctor agree that within a reasonable degree of medical certainty I can no longer think, feel anything, knowingly move, or be aware of being alive. They believe this condition will last indefinitely without hope for improvement and have watched me long enough to make that decision. I understand that at least one of these doctors must be qualified to make such a diagnosis.

Life sustaining treatment – Life sustaining treatment includes drugs, machines, or other medical procedures that would keep me alive but would not cure me. I know that even if I choose not to have life sustaining treatment, I will still get medicines and treatments that ease my pain and keep me comfortable.

Place your initials by either “yes” or “no”:

I want to have life-sustaining treatment if I am permanently unconscious. ____ Yes ____ No

Artificially provided food and hydration (Food and water through a tube or an IV) – I understand that if I become permanently unconscious, I may need to be given food and water through a tube or an IV to keep me alive if I can no longer chew or swallow on my own or with someone helping me.

Place your initials by either “yes” or “no”:

I want to have food and water provided through a tube or an IV if I am permanently unconscious.

____ Yes ____ No

O t h e r D ir e ct ion s: Please list any other things you want done or not done.

In addition to the directions I have listed on this form, I also want the following:

__________________________________________________________________________________

If you do not have other directions, place your initials here:

____ No, I do not have any other directions.

Se ct ion 2 . I f I ne e d som e one t o spe a k for m e .

This form can be used in the State of Alabama to name a person you would like to make medical or other decisions for you if you become too sick to speak for yourself. This person is called a health care proxy. You do not have to name a health care proxy. The directions in this form will be followed even if you do not name a health care proxy.

Place your initials by only one answer:

_____ I do not want to name a health care proxy. (If you check this answer, go to Section 3)

_____ I do want the person listed below to be my health care proxy. I have talked with this person

about my wishes.

First choice for proxy: ________________________________________

Relationship to me: __________________________________________

Address: ____________________________________________________

City: ____________________________ State _______ Zip ___________

Day-time phone number: _______________________________________

Night-time phone number: ______________________________________

If this person is not able, not willing, or not available to be my health care proxy, this is my next

choice:

Second choice for proxy: _______________________________________

Relationship to me: __________________________________________

Address: ____________________________________________________

City: ____________________________ State _______ Zip ___________

Day-time phone number: _______________________________________

Night-time phone number: ______________________________________

Instructions for Proxy

Place your initials by either “yes” or “no”:

I want my health care proxy to make decisions about whether to give me food and water through a tube or an IV. ____ Yes ____ No

Place your initials by only one of the following:

____	I want my health care proxy to follow only the directions as listed on this form.
_____	I want my health care proxy to follow my directions as listed on this form and to make any
	decisions about things I have not covered in the form.
_____	I want my health care proxy to make the final decision, even though it could mean doing
	something different from what I have listed on this form.

Se ct ion 3 . Th e t h in gs list e d on t h is for m a r e w h a t I w a n t .

I understand the following:

§If my doctor or hospital does not want to follow the directions I have listed, they must see that I get to a doctor or hospital who will follow my directions.

§If I am pregnant, or if I become pregnant, the choices I have made on this form will not be followed until after the birth of the baby.

§If the time comes for me to stop receiving life sustaining treatment or food and water through a tube or an IV, I direct that my doctor talk about the good and bad points of doing this, along with my wishes, with my health care proxy, if I have one, and with the following people:

____________________________________________________________________

Se ct ion 4 . M y signa t ur e

Your name: _______________________________________________________

The month, day, and year of your birth: _________________________________

Your signature: ____________________________________________________

Date signed: _______________________________________________________

Se ct ion 5 . W it n e sse s ( n e e d t w o w it n e sse s t o sign )

I am witnessing this form because I believe this person to be of sound mind. I did not sign the person’s signature, and I am not the health care proxy. I am not related to the person by blood, adoption, or marriage and not entitled to any part of his or her estate. I am at least 19 years of age and am not directly responsible for paying for his or her medical care.

Name of first witness: ___________________________________

Signature: _____________________________________________

Date: _________________________________________________

Name of second witness: _________________________________

Signature: _____________________________________________

Date: _________________________________________________

Se ct ion 6 . Sign a t u r e of Pr ox y

I, ____________________________________________, am willing to serve as the health care proxy.

Signature: ________________________________________

Date: _________________________

Signature of Second Choice for Proxy:

I, __________________________, am willing to serve as the health care proxy if the first choice

cannot serve.

Signature: ________________________________________

Date: _________________________