Georgia Living Will
This Living Will allows you to articulate your wishes regarding medical treatment in case you become unable to communicate your preferences. It is governed by the laws of the state of Georgia.
Personal Information
- Full Name: ____________________________
- Address: ____________________________
- City: ____________________________
- State: ____________________________
- Zip Code: ____________________________
- Date of Birth: ______________________
Declarant's Statement
I, the undersigned, am of sound mind and am making this declaration willingly and voluntarily. I understand that this document addresses my preferences regarding medical treatment in situations where I am unable to make decisions for myself.
Medical Treatment Preferences
- I request the following treatments to be administered, or I consent to their withholding, based on my condition:
- Life-sustaining treatments including, but not limited to:
- Artificial respiration
- Dialysis
- Cardiopulmonary resuscitation (CPR)
- Nutrition and hydration through artificial means
- I wish to receive the following care under specific circumstances:
- In case of terminal illness
- In case of a persistent vegetative state
Appointment of Healthcare Agent
In addition to my treatment preferences, I designate the following individual as my Healthcare Agent:
- Name: ____________________________
- Phone Number: ____________________________
- Relationship: ____________________________
This document should be followed in accordance with Georgia law, and I understand that I may revoke or change my Living Will at any time while I am competent. I have provided a copy of this document to my Healthcare Agent and relevant family members.
Signature
______________________________
Signature of Declarant
Date
______________________________
Date of Signature