California Living Will
California Living Will
This document, the Living Will, is designed to convey the medical preferences of [YOUR NAME] (hereinafter referred to as "the Declarant") if the Declarant becomes unable to make decisions due to incapacity or medical condition. This Living Will is established as per the laws of the State of California and aims to provide necessary instructions for healthcare providers and loved ones.
I. Declaration of Declarant
I, [YOUR NAME], residing at [YOUR COMPANY ADDRESS], being of sound mind and not under duress, coercion, or undue influence, hereby declare my wishes regarding my healthcare treatment preferences while incapacitated.
II. Appointment of Healthcare Representative
I hereby appoint the following person as my Healthcare Representative to make medical decisions on my behalf should I become incapacitated:
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Name: [REPRESENTATIVE'S NAME]
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Relationship: [RELATIONSHIP TO DECLARANT]
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Address: [REPRESENTATIVE'S ADDRESS]
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Phone Number: [REPRESENTATIVE'S PHONE NUMBER]
III. Medical Preferences
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If I am diagnosed with a terminal condition where there is no chance of recovery, I decline to receive life-sustaining treatments such as Cardiopulmonary resuscitation (CPR), Mechanical ventilation, and Artificial nutrition and hydration
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I authorize the withdrawal of life support if my condition is deemed irreversible and I am in a vegetative state with no hope of recovery.
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I request palliative care to manage pain and alleviate suffering if I am terminally ill or incapacitated.
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I hereby consent to organ donation for transplantation purposes, subject to the criteria outlined by the state of California.
IV. Effective Date
This Living Will shall become effective when I am unable to make or communicate my own health-care decisions, as verified in writing by my attending physician and one other qualified physician.
V. Revocation
I affirm my right to revoke this declaration at any time during my lifetime. Such revocation must be made in writing and signed in the presence of witnesses who are not beneficiaries named in this Will. This revocation shall only be considered valid upon proper documentation and notification to all concerned parties, including my appointed Healthcare Representative and legal representatives.
VI. Signature and Witnesses
I sign this Living Will on [Date] in the presence of the following witnesses, who also sign in my presence.
Principal
[Your Name]
Witness 1
Name: [Witness 1 Name]
Address: [Witness 1 Address]
Witness 2
Name: [Witness 2 Name]
Address: [Witness 2 Address]
VII. Notary Acknowledgment
County of [County Name], State of California
On this [Date], before me, [Notary's Name], a notary public in and for the said state, personally appeared [Your Name], known to me to be the person described in and who executed the foregoing instrument, and acknowledged that he/she executed the same as his/her free act and deed.
Witness my hand and official seal.
Notary Public: [Notary's Name]
My Commission Expires: [Expiration Date]
