North Carolina Living Will Template
This Living Will is created in accordance with North Carolina General Statutes, Chapter 90, Article 3, Part 2A. It outlines your wishes regarding medical treatment in the event that you become unable to communicate your preferences.
Personal Information:
- Full Name: _______________________________________
- Date of Birth: ___________________________________
- Address: _______________________________________
- City, State, Zip Code: _________________________
- Phone Number: __________________________________
Declaration:
I, the undersigned, being of sound mind, voluntarily make this Living Will to express my wishes regarding medical treatment in the event that I am unable to communicate my preferences due to a terminal condition or persistent vegetative state.
My Wishes:
- If I am diagnosed with a terminal condition, I do not wish to receive life-prolonging treatment.
- If I am in a persistent vegetative state, I do not wish to receive artificial nutrition and hydration.
- If I have any other specific wishes regarding medical treatment, they are as follows: _______________________________________.
Signature:
By signing below, I affirm that I am of sound mind and that I understand the contents of this Living Will.
Signature: ______________________________________
Date: __________________________________________
Witnesses:
This Living Will must be witnessed by two individuals who are not related to me by blood or marriage, and who are not entitled to any part of my estate.
- Witness 1 Name: _______________________________
- Witness 1 Signature: __________________________
- Date: ______________________________________
- Witness 2 Name: _______________________________
- Witness 2 Signature: __________________________
- Date: ______________________________________
It is important to keep a copy of this Living Will with your important documents and to share your wishes with your family and healthcare providers.