Fill form
Adobe PDF
Fill & Sign
The New Jersey Advance Directive is a contractual acknowledgment of a person’s predetermined desires surrounding health care options. This standard legal instrument serves two primary purposes for the principal party: the appointment of an attorney-in-fact for medical decisions and the declaration of preferred action(s) to take in possible scenarios. Providing this type of arranged precaution can be helpful in preparation for conceivable unforeseen occurrences.
Information: Adobe PDF
This document contains the following sections:
- Part I: Designation of a Health Care Representative
- Part II: Instruction Directive (Living Will)
Laws
Definition – “Advance directive for health care” or “advance directive” means a writing executed in accordance with the requirements of P.L.1991, c.201. An “advance directive” may include a proxy directive or an instruction directive, or both (§ 26-2H-55).
Signing Requirements – Notarization by a licensed official will be necessary or corroboration by two (2) subscribing witnessing parties (§ 26-2H-56).
Revocation – § 26-2H-57
Other Versions (8)
- AARP (Caring Connections)
- Bacharach Institute for Rehabilitation
- Five Wishes (Aging with Dignity)
- Hackensack UMC
- Jefferson Health
- NJ Catholic Conference
- Prepare for Your Care
- Valley Health System
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Bacharach Institute for Rehabilitation Version
Download: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Hackensack University Medical Center Version
Download: Adobe PDF
Information: Adobe PDF
Download: Adobe PDF
Instructions/Information: Adobe PDF
New Jersey Catholic Conference Version
Download: Adobe PDF
Information: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
Information: Adobe PDF
Additional Resources
- Cooper University Health Care – Advance Directives and Living Wills
- Middlesex County Govt. Website – What is an Advance Directive for Health Care
- Newark Beth Israel Medical Center – About Advance Directives
- NJ Dept. of Health and Senior Services – Advance Directives in New Jersey
- NJ Health Care Quality Institute – Conversations of Your Life Brochure (also available in Spanish/en Español)
- State of New Jersey Dept. of Health – Frequently Asked Questions
- State of New Jersey Dept. of Health – POLST Brochure
- State of New Jersey Dept. of Health – What is an Advance Directive
Related Forms (4)
- Advance Directive Wallet Card
- Durable (Financial) Power of Attorney Form
- POLST Form
- Psychiatric Advance Directive
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Practitioners Orders for Life-Sustaining Treatment (POLST) (also available in Spanish/en Español)
Download: Adobe PDF
Psychiatric Advance Directive (also available in Spanish/en Español)
Download: Adobe PDF
Instructions/Information: Adobe PDF
Comments