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 includes a living will and the option to designate a health care proxy to make decisions on their behalf. It is essential for individuals to understand their options and communicate their preferences clearly, ensuring their wishes are honored when needed most. To fill out the form, please click the button below.
The Alabama Directive Health Care form serves as a crucial tool for individuals seeking to articulate their medical preferences in situations where they may no longer be able to communicate their wishes. This form, often referred to as a living will and health care proxy, empowers individuals to specify the types of medical treatment they would or would not want if they become incapacitated. It encompasses several key sections, beginning with a living will that outlines preferences regarding life-sustaining treatments and artificially provided food and hydration in the event of terminal illness or permanent unconsciousness. The form allows individuals to express their desires clearly, ensuring that their healthcare providers and loved ones understand their choices. Additionally, it provides the option to designate a health care proxy—someone entrusted to make medical decisions on their behalf should they be unable to do so themselves. This designation is not mandatory, yet it can offer peace of mind knowing that a trusted individual will advocate for their preferences. The form also includes provisions for witnesses, ensuring that the directives are legally recognized and respected. Overall, the Alabama Directive Health Care form is a vital resource that not only facilitates informed decision-making but also fosters open discussions about end-of-life care among families and healthcare providers.
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.
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.
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.
I want to have food and water provided through a tube or an IV if I am permanently unconscious.
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: _______________________________________
Instructions for Proxy
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: _________________________________
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.
Completing the Alabama Directive Health Care form involves a series of steps to ensure your medical wishes are clearly communicated. Follow these instructions carefully to fill out the form accurately.
What is the Alabama Directive Health Care form?
The Alabama Directive Health Care form, also known as an advance directive, allows individuals to express their medical treatment preferences in the event they become unable to communicate their wishes. This document includes a living will and the option to designate a health care proxy who can make decisions on behalf of the individual if they become incapacitated. It is important to note that having an advance directive is not mandatory, but it is highly recommended to ensure that one's wishes are respected.
How do I complete the form?
To complete the Alabama Directive Health Care form, individuals must fill in their personal information, including their name and date of birth. They should carefully read each section, indicating their preferences regarding life-sustaining treatment and artificially provided food and hydration by initialing the appropriate sections. Additionally, if desired, they can name a health care proxy by providing their contact details. Finally, the form must be signed and dated, and two witnesses must also sign to validate the document.
What happens if I do not have a health care proxy?
If an individual chooses not to name a health care proxy, the instructions outlined in the advance directive will still be followed. The form is designed to ensure that medical personnel and family members are aware of the individual's wishes regarding treatment, regardless of whether a proxy is appointed. However, naming a proxy can provide additional clarity and support in decision-making during critical moments.
Can I change my mind after completing the form?
Yes, individuals have the right to change their decisions at any time. If someone wishes to revoke their advance directive, they can do so by tearing up the document and communicating their new wishes to someone who is at least 19 years old. It is advisable to create a new form that reflects the updated preferences and to inform family members and healthcare providers about any changes made.
What should I do with the completed form?
Once the Alabama Directive Health Care form is completed and signed, it is essential to share copies with relevant parties. This includes your primary care physician, family members, and anyone designated as a health care proxy. Keeping the original document in a safe and accessible location is also important, as it may be needed in medical emergencies.
What if my healthcare provider does not follow my wishes?
If a healthcare provider or facility refuses to honor the directives outlined in the advance directive, they are required to refer the individual to another provider who will comply with the specified wishes. It is crucial for individuals to understand that their preferences must be respected, and they have the right to seek care from providers who will uphold their directives.
Filling out the Alabama Directive Health Care form can be straightforward, but there are common mistakes that people often make. One major error is not providing complete personal information. Ensure that all sections, including your name, birth date, and contact information, are filled out clearly. Missing information can delay the processing of your wishes.
Another frequent mistake is failing to initial the required sections. Each choice regarding life-sustaining treatment and food hydration must be marked. If you skip this step, your preferences may not be honored. It’s essential to double-check that you’ve placed your initials beside your choices.
Many individuals overlook the importance of discussing their wishes with their health care proxy. If you decide to appoint someone to make decisions on your behalf, ensure that you have talked about your preferences. This conversation is crucial for your proxy to understand your values and wishes.
Some people mistakenly believe that they can change their directives without proper documentation. While you can change your mind, it’s important to formally revoke the previous directive by tearing it up and creating a new one. Simply stating your new wishes verbally may not be sufficient.
Failing to have the required witnesses sign the form is another common issue. The Alabama Directive Health Care form requires two witnesses who are not related to you and who do not stand to gain from your estate. Make sure to have these signatures completed to validate your directive.
In addition, people often forget to include any specific additional instructions. If you have unique requests that are not covered in the standard options, write them down in the designated section. This ensures that all your wishes are documented and can be followed.
Sometimes, individuals do not consider the implications of their choices. For instance, if you choose not to receive life-sustaining treatment, understand that this decision can have significant consequences. Take the time to reflect on your choices and discuss them with family or medical professionals.
Another mistake is not keeping a copy of the completed form. After filling it out, make sure to keep a copy for your records. Share this copy with your health care proxy, family, and your doctor. This ensures that everyone is aware of your wishes.
Lastly, people often neglect to review their directive periodically. Life circumstances can change, and so can your preferences. Regularly reviewing and updating your advance directive ensures that it accurately reflects your current wishes.
The Alabama Directive Health Care form, also known as a living will and health care proxy, serves a crucial role in outlining an individual's medical treatment preferences. When preparing this document, several other forms and documents may also be relevant to ensure comprehensive health care planning. Below is a list of these documents, along with a brief description of each.
In summary, these documents work in tandem with the Alabama Directive Health Care form to create a comprehensive approach to health care planning. Understanding each form's purpose can help individuals make informed decisions about their medical care and ensure that their wishes are respected in critical situations.
The Alabama Directive Health Care form is similar to several other important documents that help individuals express their medical treatment preferences. Here are seven documents that share similarities:
When filling out the Alabama Directive Health Care form, it's crucial to approach the process thoughtfully. Here are some essential dos and don’ts to keep in mind:
By following these guidelines, you can help ensure that your health care wishes are respected and followed when it matters most.
Understanding the Alabama Directive Health Care form is essential for making informed decisions about your medical care. However, several misconceptions can lead to confusion. Here are seven common misconceptions about this important document:
Being aware of these misconceptions can empower you to make informed choices regarding your health care preferences. Always consult with a trusted professional if you have questions about the form or your specific situation.
Understanding the Alabama Directive Health Care form is essential for making your medical wishes known. Here are some key takeaways to consider: