New Jersey Living Will Template
This Living Will template is designed for individuals residing in New Jersey, in accordance with the New Jersey Advance Directives for Health Care Act (N.J.S.A. 26:2H-53 et seq.). This document expresses your wishes regarding medical treatment in the event you become unable to communicate those wishes yourself.
Please fill in the following information:
- Full Name: _________________________________
- Date of Birth: ___________________________
- Address: _________________________________
- City, State, Zip Code: ____________________
- Phone Number: ___________________________
In the event that I become terminally ill or permanently unconscious and unable to communicate my wishes, I direct that my healthcare providers follow these instructions:
- Life-Sustaining Treatment: I do not wish to receive life-sustaining treatment that would only prolong the dying process. (Initial: ____)
- Pain Relief: I wish to receive medication for pain relief, even if it may hasten my death. (Initial: ____)
- Artificial Nutrition and Hydration: I do not wish to receive artificial nutrition and hydration. (Initial: ____)
- Organ Donation: I wish to donate my organs for transplantation. (Initial: ____)
This Living Will should be provided to my healthcare representatives and included in my medical records. It is my intent that my wishes will be respected and followed. I understand that I can revoke this Living Will at any time, as long as I am of sound mind.
Signature: ___________________________
Date: ______________________________