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Continue Care Reverse Of Living Will
The State of [State] decided when it passed a living will law that it would not only pass a law allowing persons to limit their medical care, but they would also allow persons to make a statement that they wanted all possible medical care even if their cases were terminal. This form provides that if your wish is that all possible medical care be given, that this is done. There is an option to state you are revoking a prior living will. You may complete one of these forms, even if you don't live in [State].
DECLARATION OF DESIRES AS TO MEDICAL CARE
I, [Name], desire to make aware that after mature reflection, and, being aware of the right under the law to decline life-sustaining treatment, that I wish, should I ever be unable to make decisions for myself concerning my medical treatment that I receive life sustaining treatment even after a terminal diagnosis, even if the life prolonging treatment will delay the natural process of dying.
I have previously made a "living will" or other document expressing a desire contrary to that specified herein, and by this document I herewith revoke the same.
Print Name and Address
This Section for Notary:
STATE OF -------)
) ss: [date]
COUNTY OF ------)
On [Date] before me, [Name of Notary], notary, personally appeared [Name of Person(s) Involved], personally known to me (or proved to me on the basis of satisfactory evidence) to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument.
Witness my hand and official seal.
[Name of Notary Public]
My commission expires: [date]