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Statute – “If there is no person in a prior class who is reasonably available, willing, and competent to act, an agent acting pursuant to a valid mandate, specifically authorizing the agent to make health care decisions, is authorized and empowered to consent, either orally or otherwise, to any surgical or medical treatment or procedures including autopsy not prohibited by law which may be suggested, recommended, prescribed, or directed by a duly licensed physician.” (§ 1159.4(A)(3))
Signing Requirements – Acknowledgment of Two (2) Witnesses (notarization optional)
Other Versions (4)
Franciscan Missionaries of Our Lady Health System Version
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Additional Resources
- Lallie Kemp Medical Center – You Decide Brochure
- Louisiana Healthcare Connections – Advance Medical Directives
- Louisiana State Bar – End-of-Life Decisions
- Ochsner Health – Advance Care Planning Conversations (in Spanish, in Vietnamese)
- Peoples Health – Louisiana Advance Directives Handout
Related Forms (6)
- Advance Directive (Medical POA & Living Will)
- Advance Directive for Mental Health Treatment
- Advance Directive Wallet Cards
- Durable (Financial) Power of Attorney
- HIPAA Authorization Form
- Physician Orders for Scope of Treatment (LaPOST) Form
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF
Advance Directive for Mental Health Treatment
Download: Adobe PDF
Laws: RS 28:221 et sec.
Advance Directive Wallet Cards
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
HIPAA Authorization Form (specific to Blue Cross, Blue Shield, & HMO)
Download: Adobe PDF
Physician Orders for Scope of Treatment (LaPOST) Form
Download: Adobe PDF
Spanish Version: Adobe PDF
Laws: RS 40:1155.1 et seq.
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