Louisiana Living Will Template
This Living Will is made in accordance with Louisiana state laws regarding advance directives.
Personal Information:
- Name: ______________________________
- Date of Birth: ______________________
- Address: ____________________________
- City: _______________________________
- State: ______________________________
- Zip Code: __________________________
Declaration:
I, the undersigned, being of sound mind, make this Living Will to express my wishes regarding medical treatment in the event that I become unable to communicate my preferences.
Medical Treatment Preferences:
If I am diagnosed with a terminal condition or am in a persistent vegetative state, I direct that:
- Life-sustaining treatments be withheld or withdrawn.
- I receive comfort care to alleviate pain and suffering.
Appointment of Health Care Proxy:
I appoint the following person to make health care decisions on my behalf if I am unable to do so:
- Name of Proxy: ______________________
- Phone Number: ______________________
- Relationship: ________________________
Witnesses:
This document must be signed in the presence of two witnesses who are not related to me and who will not inherit from me.
- Witness Name: ______________________
- Witness Signature: __________________
- Date: ______________________________
- Witness Name: ______________________
- Witness Signature: __________________
- Date: ______________________________
Signature:
By signing below, I affirm that I am of sound mind and that I understand the contents of this Living Will.
Signature: ____________________________
Date: _________________________________