New Jersey Living Will
This Living Will is executed in accordance with the provisions set forth in the New Jersey Statutes. It allows individuals to express their wishes regarding medical treatment in the event they become unable to communicate their desires.
Declarant Information:
- Name: _________________________________
- Date of Birth: _________________________
- Address: _______________________________
- City, State, Zip Code: _________________
Healthcare Directives:
In the event that I am unable to make my own healthcare decisions due to incapacitation or a terminal illness, I express my wishes as follows:
- I do not wish to receive life-sustaining treatment if:
- I am diagnosed with a terminal condition.
- I am in a permanent unconscious state.
- I wish to receive comfort care and pain relief even if it may hasten my death.
- If I can no longer make healthcare decisions, I appoint the following individual as my healthcare representative:
- Name: __________________________________
- Relationship: _____________________________
- Phone Number: ____________________________
Signature:
By signing below, I confirm that I am of sound mind and am voluntarily executing this Living Will.
Signature: _________________________________
Date: ______________________________________
Witnesses Required:
- Witness 1 Name: ________________________
- Witness 1 Signature: ____________________
- Date: __________________________________
- Witness 2 Name: ________________________
- Witness 2 Signature: ____________________
- Date: __________________________________
This document should be kept in a safe place and provided to your healthcare representatives.