This form is for use in the District of Columbia, Maryland and Virginia. This form cannot be filled from your computer. In order to use it you need to download it, fill in the blanks, and sign it. The combined advances directives contained in the electronic forms are, when properly understood and executed, your durable power of attorney for health care, living will, and other wishes.
Directions Read each section carefully.
You may want to review a list of definitions in order to better understand the meaning of some of the words used in the advance directive. Place the initials of your name on the blank line before those choices you want to make. Add any special instructions in the blank spaces provided. Sign the form in the presence of two witnesses and have them sign in your presence. This page was prepared on 15 December 1997 and it is based on a document prepared by the District of Columbia Hospital Association.