Thank you for downloading our template.
If you find the document valuable, please leave us a review. It really helps us get the word out and makes what we're doing even more worthwhile.
One may designate an agent to decide on choices about health care and end-of-life treatment under an Alabama advance directive. The elderly and those in more precarious health circumstances are more likely to fill out this form. This document should be maintained in a secure and accessible location during health emergencies once it has been signed
Laws and Guidelines
Statute – § 22-8A-4
Requirements needed for signing (§ 22-8A-4(c)(4))- A minimum of two witnesses, both aged 19 at the least, is required and neither of them may be the principal's agent, a family member, or a person allowed to any share of the principal's estate or medical treatment.
Definition of the State (§ 22-8A-3(3))-Section 22-8A-3(3) of the State Definition includes Living wills, health care representative appointments, or a combination of the two.
How and Where to write
1st Section
Living Will
(1) Alabama Principal Declaration/Affirmation
The Principal's identification is sought in the first sentence of this order. Your medical choices should be documented for consideration by Alabama Clinical Staff if you are unable of communicating and must provide permission or rejection of treatment. Produce your identity as the Party responsible for this. Report the Principal's name if you're working with or for them.
when Illness or injury may be life-threatening.
(1) Life-Supporting Preferences- Starting with your desire for life-sustaining care, this document acts as your wishes at a time that you are unable to speak and make decisions for yourself. By signing the "Yes" or "No" lines are given, you will indicate whether you agree or disagree with Alabama Medical Staff's procedures and/or treatments necessary to maintain life that are essential to extend your life.
(3)Your instructions on artificial nutrition. – Food and drink supply through tube or IV is another technique that Alabama physicians will ask for your permission before carrying out. When the Alabama Hospital personnel wants to provide food and drink using these techniques, you may signal your agreement or disapproval by signing your name. To avoid starving or dehydration, you should pick "No" if unable to eat or drink for an extended period/duration.
When unconscious indefinitely
(4) Life-Supporting Tips. It is a given in Alabama that doctors and medical staff will attempt to extend your life with life-saving therapies if you are made irreversibly unconscious (i.e., intubation/breathing equipment or dialysis machine). If you are left permanently unconscious, you have the option of either providing permission via this paper or informing Alabama Physicians of your wishes.
(5) Directives on artificial nourishment. For those who are chronically unconscious, it is important to outline your choices for obtaining meals and fluids via intubation or IV. When you are chronically unconscious and unable to eat or drink on your own, this directive demands your consent to indicate whether or not you want to receive artificial sustenance.
Other Possible Paths
(6) Your Recommendation. When you are diagnosed with a terminal (incurable) illness or are permanently unconscious, the preceding directions are deemed essential. Other difficulties may also be addressed as a patient in Alabama. You may use this document to express your preferences on when certain therapies are acceptable and when they are not your medication status, or whether terminal situations are appropriate for this document. Licensed physicians should be consulted before writing these recommendations on paper. As a result, you must offer a comprehensive report. If more space is required, an attachment may be added.
(7) More Directive Status- This section should be signed off with an initial if you don't have any more instructions to provide to the reviewers. Please note that Alabama Physicians will seek further instructions from you to properly understand your medical choices if this statement is ignored.
2nd Section. What if I need someone else to speak on my behalf?
(8) Proxy appointment for health care. The appointment of your Health Care Proxy is likewise permitted in Alabama. As a result, you have the option of legally designating a representative to represent your medical interests in the state of California. Even though you may choose not to name an Alabama Health Care Proxy on this form, your choice must be memorialized. Start with the sentence that most accurately expresses your goal.
(9) Your preferred or first proxy choice. The first step in appointing a Health Care Proxy is to note the full name of the individual and the connection they have with you.
(10) The home address of the proxy's first choice.
(11) Phone Number of First Preference (s).
(12) Second or alternative proxy choice
It is possible to be left without representation if your initial choice for an Alabama Health Care Proxy is unable or unwilling to act on your behalf with Physicians when you are incapacitated and in need of invasive medical care. Adding a second option to your Alabama Health Care Proxy will help to balance out the effects of this potential threat to your personal information.
(13) Contact information for the second proxy choice.
(14) The Phone Number of a Second Alternative (s).
The Power of Proxy in healthcare
(15) A Proxy For The Nutrition Directive. You may give your Alabama Health Care Proxy the authority to accept or reject the attempts of Alabama Doctors to artificially supply sustenance and fluids (i.e. through a tube) by initialing the statement that best reflects your desire. If you want to give your Alabama Health Care Proxy the ability to determine whether or not artificial nourishment and water are delivered, initial the "Yes" line. If you don't, initial the "No" line.
(16) Status as a Health Care Proxy. Your Alabama Health Care Proxy's position in respect to your living will have to be made crystal clear to you. For this reason, one of four statements might be used. Your initials are all that is needed for you to tell the health care proxy to follow your instructions on this form even if you are currently in a situation where you are unable to speak for yourself. You can also give your health care proxy the authority to override the directives you set in this form if unforeseen events or treatment options arise.
3rd Section. 3 What Is Listed Here Is What I'm Looking For
(17) Principal or main parties that are concerned. The main parties are worried about this issue (17). You may use the given area to add the names and contact information of those who should be contacted and discussed with if your Health Care Proxy has concluded that artificial feeding and life-sustaining treatment should be discontinued.
4th Section – My Details and Signature
(18) Your Full Name
You must give a dated signature attested by two witnesses to set this document into action as an accurate and current representation of your medical choices (who are unrelated to you, not named as your Agent, and unaware of any entitlements or bequeathments). To get started, write down your name.
(19) Full Date of birth including Day, month, and year
A brief description of your date of birth is provided in item number 19. By providing your birth date, you may prove your identity to reviewers.
(20) You have to sign. Sign this form in front of two witnesses with your full name.
(21) Date of Signing. Following your signature, you may create a current calendar date.
5th Section. Witnesses
(22) First Witness's Name. It is essential that both witnesses certify to their qualifications in Alabama and that your signature was authenticated by you. The First Witness must write down his or her name before giving such a statement.
(23) Witnesses Signature. For this document to be signed, Witness 1 must attest to the information provided about his or her credentials, as well as your signature.
(24) Date of signing. The date on Witness 1's signature should match yours, of course.
(25) Name and signature of a second witness are required. It is required that Witness 2 print his or her name, sign this paper, and give a record of the current date to show that the testimony above is correct.
6th Section: Proxy Signature
(26) The Proxy Statement of First Choice Health Care. This paper should be provided to both of your healthcare proxies for safekeeping. Before the last part can be deemed complete, you must have your first choice for Health Care Proxy sign and date this agreement to accept the responsibilities that come with this job.
(27) The signature of a second choice for a proxy has been obtained. Second choice Health Care Proxy should sign and date a second acknowledgment statement with his or her printed name to indicate that he or she may be called upon to take on the function of your Health Care Proxy in Alabama.