Illinois Living Will Template
This Illinois Living Will expresses your wishes regarding medical treatment in the event that you become unable to communicate your preferences. This document is in accordance with the Illinois Living Will Act.
Important Note: This is a template and should be customized to fit your personal needs. It's advisable to consult an attorney or legal expert to ensure it meets all legal requirements.
Instructions: Fill in the blanks below with your information.
Your Information:
- Name: ______________________________
- Address: ______________________________
- City, State, Zip Code: ______________________________
- Date of Birth: ______________________________
Declaration:
In the event that I am diagnosed with a terminal condition or am in a state of permanent unconsciousness, I do hereby declare that:
- I do not wish for my life to be prolonged by artificial means.
- I want to receive comfort care and pain relief regardless of my life expectancy.
- I wish for my healthcare providers to follow my wishes as indicated in this document.
Signature:
By signing below, I affirm that I understand the contents of this Living Will and that it reflects my wishes with regard to medical treatment.
_______________________________
(Signature)
Date: ____________________________
Witnesses:
This document should be signed in the presence of two adult witnesses.
- Witness 1 Name: ______________________________
- Witness 1 Signature: ______________________________
- Date: ______________________________
- Witness 2 Name: ______________________________
- Witness 2 Signature: ______________________________
- Date: ______________________________
Healthcare Proxy:
If you wish to appoint a healthcare proxy, please include their information below:
- Name: ______________________________
- Address: ______________________________
- Phone Number: ______________________________
This Living Will supersedes any prior Living Wills or similar documents made by me.