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ADVANCE MEDICAL DIRECTIVE

An Advance Medical Directive (also known as a Living Will) is a document, separate from the will, that provides instructions to your health care provider as to what you want done in the event that you become incapacitated and are in a terminal condition. This is your chance to tell your doctor if you want life support or not to help keep you alive. To ensure that doctors and hospitals follow the living will, one or two "agents" are appointed to act on behalf of the testator in health care matters. If the testator appoints two agents, he may require them to act jointly or he may permit the second to act only if the first cannot or will not act.

ADVANCE MEDICAL DIRECTIVE (LIVING WILL) QUESTIONNAIRE

Advance Medical Directive (Living Will) Questionnaire

Download this file and save it in your hard drive. Once you have completed the form, please mail the form to:
Commander (dl)
Ninth Coast Guard District
1240 East Ninth Street
Cleveland, OH 44199-2060
Fax: (216) 902-6055


Or, e-mail to: Stephen.T.Lynch@uscg.mil

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Last Modified 6/13/2012