Fill form
Adobe PDF
Fill & Sign
The Pennsylvania Advance Directive ascertains a prearranged written understanding of the requests of a principal party for future health care options. The formal agreement links the practical measures of securing a nominated agent and recording treatment preferences for medical action within one (1) form. Preemptively designating the declarant’s favored choices regarding life support, resuscitation, and pain management can give the physicians an idea of how to proceed even if the patient succumbs to possible incapacitation. Other areas of the document serve to classify the principal’s desires on handling situations regarding religious or spiritual rituals, location of end-of-life care, and/or funeral specifications. Once signed and witnessed, it is important to retain the original form and make copies to distribute and discuss with trusted friends or family members.
(If organ donation is desired, it is necessary to register with the Pennsylvania Department of Transportation in addition to filing advance directive paperwork.)
This document contains the following sections:
- Part I: Medical Power of Attorney
- Part II: Living Will
Laws
Statute – Pennsylvania Statutes Title 20, Chapter 54 – Health Care
Definitions – “Advance health care directive” means a health care power of attorney, living will or a written combination of a health care power of attorney and living will (§ 5422).
Signing Requirements – Execution of the contract will require two (2) witnessing parties to view the signing process and endorse as needed. Witnesses must be at least eighteen (18) years of age and cannot be the individual designated to sign on behalf of the principal (§ 5442).
Revocation – § 5444
Other Versions (10)
- AARP (Caring Connections)
- Allegheny County Bar Assoc.
- Five Wishes (Aging with Dignity)
- Guthrie Medical
- Lancaster General Health
- Main Line HealthCare
- Pennsylvania Catholic Conference
- Penn State Health
- Prepare for Your Care
- Summit Health
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Allegheny County Bar Association Version
Download: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Download: Adobe PDF
Lancaster General Health Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
Pennsylvania Catholic Conference Version
Download: Adobe PDF
Download: Adobe PDF
Instructions: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
Instructions: Adobe PDF
Additional Resources
- Allegheny County Health Department – Writing an Advance Directive
- Donate Life Pennsylvania – About Donation
- Hazen Law Group – The Need for Advance Directives
- Jefferson Health – Advance Directives, Living Wills, and Power of Attorney
- Mental Health Association in Pennsylvania – Mental Health Advance Directives
- Penn Highlands Healthcare – Advance Directives
- PA Health & Wellness – Advance Directive
- PA Law Help – Advance Directives, Guardianships, Powers of Attorney, and Living Wills
- Penn Medicine – Advance Directives
- Pennsylvania Department of Aging – Advance Directives Information Packet
- Tyrone Regional Health Network – Advance Directives: Legal Documentation Covering Future Care
Related Forms (4)
- Advance Directive Wallet Card
- Durable (Financial) Power of Attorney Form
- Mental Health Advance Directive Form
- POLST Form
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Mental Health Advance Directive Form
Download: Adobe PDF
Instructions: Adobe PDF
Pennsylvania Orders for Life-Sustaining Treatment (POLST)
(also available in Spanish/en Español)
Download: Adobe PDF
Instructions: Adobe PDF
Comments