Minnesota Statutory

Health Care Living Will 

Notice:

    This is

an important legal document.  Before signing this document, you should know these important facts:

    (a) This

document gives your health care providers or your designated proxy the power and guidance to make health care decisions according to your wishes when you are in a terminal condition and cannot do so.  This document may include what kind of treatment you want or do not want and under what circumstances you want these decisions to be made.  You may state where you want or do not want to receive any treatment.

    (b) If you

name a proxy in this document and that person agrees to serve as your proxy, that person has a duty to act consistently with your wishes.  If the proxy does not know your wishes, the proxy has the duty to act in your best interests. If you do not name a proxy, your health care providers have a duty to act consistently with your instructions or tell you that they are unwilling to do so.

    (c) This

document will remain valid and in effect until and unless you amend or revoke it.  Review this document periodically to make sure it continues to reflect your preferences.  You may amend or revoke the living will at any time by notifying your health care providers.

    (d) Your

named proxy has the same right as you have to examine your medical records and to consent to their disclosure for purposes related to your health care or insurance unless you limit this right in this document.

    (e) If there

is anything in this document that you do not understand, you should ask for professional help to have it explained to you.   

TO MY FAMILY, DOCTORS, AND

ALL THOSE CONCERNED WITH MY CARE:  

    I, ______________________________,

born on ______________________  (birthdate), being an adult of

下一页