California Living Will
This Living Will is created in accordance with the California Probate Code. It outlines your healthcare wishes in the event you become unable to communicate your preferences.
Individual Information
- Full Name: _______________________________
- Date of Birth: _________________________
- Address: _______________________________
- City, State, Zip: ______________________
- Phone Number: _________________________
Instructions for Healthcare Treatment
If I am unable to make my wishes known regarding medical treatment, I express my desires through this document:
- I do not wish to receive treatment that would merely prolong the dying process if I have:
- End-stage condition
- Terminal illness
- Persistent vegetative state
- In the event that I am unable to communicate, I would prefer the following life-sustaining treatments:
- Artificial nutrition and hydration
- Mechanical ventilation
- Cardiopulmonary resuscitation (CPR)
Date: _________________________
Signature: _________________________
Witness Information
- Witness 1 Name: __________________________
- Witness 1 Signature: _____________________
- Date: ______________________________
- Witness 2 Name: __________________________
- Witness 2 Signature: _____________________
- Date: ______________________________
This Living Will should be kept in a safe yet accessible location and shared with your healthcare provider to ensure your wishes are honored.