PREPARING YOUR LAST WILL & TESTAMENT AND RELATED DOCUMENTS.

LIVING WILL

A “LIVING WILL” is not really a “Will” but a “HEALTH CARE PROXY” or “MEDICAL TREATMENT DIRECTIVE, which are terms used in many other states.

A properly prepared LIVING WILL must be recognized and honored by any hospital, doctor or other health care facility entrusted with your medical care.

New Jersey is the 48th State to give ”LIVING WILLS” full legal recognition.

The law’s original sponsor, former Senator Gabriel Ambrosio, said that New Jersey has the “best Living Will law in the Nation.”

A LIVING WILL is a legal document which enables you to do two (2) very important things:

1) Clearly and unequivocally express your specific desires regarding life-sustaining or prolonging treatments you do not want administered in the event you become seriously injured or gravely ill to the point where you cannot make such decisions for yourself; and

2) Permits you to designate an individual (and alternate individual) to whom such decisions are to be entrusted.

 

PERSONAL INFORMATION ( PLEASE PRINT CLEARLY )

NAME______________________________________________________________

DATE OF BIRTH___________SOCIAL SECURITY NUMBER__________________

ADDRESS__________________________________________________________

                              (street number and name) (city) (county) (state) (zip)

HOME TELEPHONE#___________________CELL PHONE#__________________

ANY EXISTING LIVING WILLS? [ ] YES [ ] NO; IF YES , WHERE LOCATED ________________________________________

  1. Typically, the life sustaining/prolonging medical treatments that most people desire to be terminated or not administered in the event of serious incapacitation include feeding tubes, respirators, ventilators, or any other drug or treatment used solely for prolonging life, except treatments and drugs used to alleviate pain and suffering.

               If you specifically desire any other treatments be either withheld or administered, please list same here: ____________

          _______________________________________________________________________________________________

  1. To whom do you wish to entrust the responsibility of making such medical treatment decisions in accordance with your above directives? Out of possible necessity, list an alternate individual to whom you would entrust such decisions should your first choice be unable or unwilling to act. Please list complete names and addresses.

                           FIRST CHOICE                                                                              SECOND CHOICE

NAME_______________________________________        NAME_________________________________________

ADDRESS____________________________________      ADDRESS_____________________________________

_____________________________________________      ______________________________________________

PHONE #____________________________________         PHONE#______________________________________

RELATIONSHIP_______________________________         RELATIONSHIP_________________________________

  1. In the event it is necessary for the actions outlined above to be taken, do you wish to make any specific provisions for organ donation? [ ] YES [ ] NO

          IF YES , detail specific provisions:___________________________________________________________________

          _________________________________________     _______________

                               Your signature                                                       Today’s date

Please complete this entire questionnaire and return to our office. Thank you. This document is designed for general information only. The information presented here should not be construed to be formal, legal advice nor the formation of a lawyer/client relationship. Call us with questions pertaining to this topic or a Free Legal Consultation.

JEFFREY M. ADAMS

ATTORNEY AT LAW

609 MAIN STREET, 2nd Floor

TOMS RIVER, NJ 08753

732 281 3005

732 281 3006 FAX LINE

EMAIL: JMADAMSLAW@COMCAST.NET

WWW.JMADAMSLAWFIRM.COM

© Jeffrey M. Adams, January 2007

All rights reserved. You may copy this document for your own personal use with proper credit given the author and copyright information included. You may not copy and distribute this material for commercial purposes without the express written consent of the author.