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Oklahoma Advance Directive for Health Care

Use to document a patient’s healthcare preferences, appoint a healthcare proxy, and record any organ donation wishes. Complete fully and obtain required signatures.

Advance Directive for Health Care

State of Oklahoma

Personal Information

Date of Birth
Month
Day
Year

If I am incapable of making an informed decision regarding my health care, I direct my health care providers to follow my instructions below.

I. Living Will

If my attending physician and another physician determine that I am no longer able to make decisions regarding my medical treatment, I direct my attending physician and other health care providers, pursuant to the Oklahoma Advance Directive Act, to follow my instructions as set forth below:

1. Terminal Condition

If I have a terminal condition, that is, an incurable and irreversible condition that even with the administration of life-sustaining treatment will, in the opinion of the attending physician and another physician, result in death within six (6) months:

Choose one option only
I direct that my life not be extended by life-sustaining treatment, except that if I am unable to take food and water by mouth, I wish to receive artificially administered nutrition and hydration.
I direct that my life not be extended by life-sustaining treatment, including artificially administered nutrition and hydration.
I direct that I be given life-sustaining treatment and, if I am unable to take food and water by mouth, I wish to receive artificially administered nutrition and hydration.

Check if applicable

2. Persistently Unconscious

If I am persistently unconscious, that is, I have an irreversible condition, as determined by the attending physician and another physician, in which thought and awareness of self and environment are absent:

Choose one option only
I direct that my life not be extended by life-sustaining treatment, except that if I am unable to take food and water by mouth, I wish to receive artificially administered nutrition and hydration.
I direct that my life not be extended by life-sustaining treatment, including artificially administered nutrition and hydration.
I direct that I be given life-sustaining treatment and, if I am unable to take food and water by mouth, I wish to receive artificially administered nutrition and hydration.

Check if applicable

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