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This document contains the following sections:
- Part I: Appointment of Health Agent (Medical Power of Attorney)
- Part II: Health Care Instructions (Living Will)
- Part III: Making the Document Legal (Acknowledgment of Principal by Witnesses/Notary Public)
Laws
Statutes – Chapter 145C: Health Care Directives
Definition – “Health care directive” means a written instrument that complies with section 145C.03 and includes one or more health care instructions, a health care power of attorney, or both; or a durable power of attorney for health care executed under this chapter before August 1, 1998 (§ 145C.01(5a)).
Statutory Form – § 145C.16
Signing Requirements – Acknowledgment of Two (2) Witnesses and/or a Notary Public (§ 145C.03(1)(5))
Revocation – § 145C.09
Other Versions (17)
- AARP
- Allina Health
- Allina Health (Large Font)
- Allina Health (Short Form)
- Blue Cross and Blue Shield of Minnesota
- Five Wishes (Aging with Dignity)
- Funeral Consumers Alliance
- Hennepin Health
- Honoring Choices Minnesota (4 Page)
- Honoring Choices Minnesota (8 Page)
- Honoring Choices Minnesota (Large Font)
- Honoring Choices Minnesota (Short Form)
- Mayo Clinic
- Minnesota Legal Services Coalition
- Minnesota State Bar Association
- Prepare for Your Care
- University of Minnesota
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Instructions: Adobe PDF
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Allina Health – Large Font Version
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Allina Health – Short Form Version
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Blue Cross and Blue Shield of Minnesota Version
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Five Wishes (Aging with Dignity) Version
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Information: Adobe PDF
Funeral Consumers Alliance Version
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Download: Adobe PDF
Information: Adobe PDF
Honoring Choices Minnesota – 4 Page Version
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Guide: Adobe PDF
Honoring Choices Minnesota – 8 Page Version
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Guide: Adobe PDF
Honoring Choices Minnesota – Large Font Version
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Short Form: Adobe PDF
Honoring Choices Minnesota – Short Form Version
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Minnesota Legal Services Coalition Version
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Minnesota State Bar Association Version
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University of Minnesota Version
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In Spanish: Adobe PDF
Multilingual Versions (7)
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Long Form: MS Word (.docx)
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Long Form: MS Word (.docx)
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Long Form: MS Word (.docx)
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Long Form: MS Word (.docx)
Download: Adobe PDF
Additional Resources
- Allina Health – Advance Care Planning Discussion Guide
- Allina Health – CPR and Advance Care Planning
- Allina Health – Making Your Health Care Choices Known
- Honoring Choices Minnesota – Advance Care Planning and COVID-19
- Honoring Choices Minnesota – Advance Care Planning General Guide
- Honoring Choices Minnesota – Advance Care Planning Terms to Know
- Honoring Choices Minnesota – Artificial Hydration and Nutrition Information
- Honoring Choices Minnesota – Cardiopulmonary Resuscitation (CPR) Information
- Honoring Choices Minnesota – Choosing a Health Care Agent
- Honoring Choices Minnesota – Dialysis Information
- Honoring Choices Minnesota – Help with Breathing
- Honoring Choices Minnesota – Implantable Cardioverter-Defibrillator (ICD) Info
- Honoring Choices Minnesota – Things to Consider When Planning
- Minnesota Board of Aging – Planning Ahead for Your Future
- Minnesota Legal Services Coalition – Advance Directive Fact Sheet (In Spanish)
- POLST Minnesota – Advance Care Planning and POLST
- POLST Minnesota – Completing POLST in the AL or SNF
- POLST Minnesota – Completing POLST in the Clinic Setting
- POLST Minnesota – Conversations for Clinic or Homecare Patients
- POLST Minnesota – Conversations for Patients Entering Hospice
- POLST Minnesota – Frequently Asked Questions (FAQ)
- POLST Minnesota – Guidelines for Remote POLST Completion
- POLST Minnesota – Information for Patients and Family Members
- POLST Minnesota – POLST and COVID-19 Guide
Related Forms (6)
- Advance Directive Wallet Cards
- Advance Psychiatric and Health Care Directive
- Durable (Financial) Power of Attorney
- “Make My Wishes Clear” Addendum
- Organ Donation Form
- Provider Orders for Life-Sustaining Treatment (POLST) Form
Advance Directive Wallet Cards
Download: Adobe PDF
Advance Psychiatric and Health Care Directive
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF
“Make My Wishes Clear” Addendum
Download: Adobe PDF
Download: Adobe PDF
Provider Orders for Life-Sustaining Treatment (POLST) Form
Download: Adobe PDF
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