This Montana Living Will template is designed in accordance with the Montana Rights of the Terminally Ill Act. It allows you, the declarant, to outline your wishes regarding medical treatment in the event that you are unable to communicate your decisions due to a terminal condition or persistent vegetative state. By completing this document, you can ensure that your healthcare providers and loved ones are aware of your preferences concerning life-sustaining treatments, artificial nutrition, and hydration.
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INFORMATION OF THE DECLARANT
Full Name: ________________________________________________________
Date of Birth: ________________________
Social Security Number: _______________________________ (Optional)
Primary Residence: ____________________________________________________
City: ___________________________ State: Montana Zip Code: ___________
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HEALTHCARE DIRECTIVES
I, ___________________________ (Full Name), born on ________________________, being of sound mind, voluntarily make known my wishes regarding my healthcare, directing that:
- My healthcare providers should withhold or withdraw life-sustaining treatment if I am in a terminal condition or in a persistent vegetative state from which there is no reasonable expectation of recovery.
- The provision of artificially supplied nutrition and hydration is to be withheld or withdrawn if the probable risks and burdens associated with the treatment would outweigh the expected benefits, according to my judgment.
- I designate the following individual as my healthcare agent to make decisions on my behalf if I am incapable of making my own healthcare decisions:
Name: _______________________________________________
Relationship to me: _________________________________
Contact Number: _____________________________________
- In any situation where the intentions of this document are not clear, my agent has the authority to interpret my wishes based on their understanding of my values and preferences.
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SIGNATURES
This document represents my directions as noted above. I sign this living will on this date, _____ (day) of ________________ (month), __________ (year), in the State of Montana.
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(Signature of the Declarant)
Address: ___________________________________________________________________
Witness Statement:
I declare that the person signing this document is personally known to me and appears to be of sound mind and under no duress, fraud, or undue influence. I am not the person appointed as the agent by this document, nor am I the declarant’s healthcare provider.
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Signature of Witness #1
Address: ___________________________________________________________________
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Signature of Witness #2
Address: ___________________________________________________________________
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IMPORTANT INFORMATION
This Montana Living Will becomes effective only when you are unable to communicate your healthcare decisions. It is recommended that you discuss your choices with your family, close friends, and healthcare providers. Ensure copies of this document are distributed to your healthcare agent, primary physician, and healthcare institution where you receive care.
Keep the original document in a secure but accessible location, and inform your healthcare agent of this location. Review and update your living will as necessary to reflect your current wishes.