The Minnesota Advance Directive, or “Health Care Directive”, informs one’s family and doctor of what their preferred medical protocol would be at the time of incapacity. Apart from declaring their own wishes concerning various health care predicaments, they will also have the capability of assigning an individual to handle similar decisions for them. For this to materialize, the executor (principal) must furnish the form with the names of the involved parties, descriptions of their priorities regarding medical care, and their signature which is to be witnessed by two (2) attesting individuals and/or a notary public. Following the execution of this document, the principal should provide copies to any relevant party and also preserve another for their own records.
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)
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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
Download: Adobe PDF
Instructions: Adobe PDF
Download: Adobe PDF
Allina Health – Large Font Version
Download: Adobe PDF
Allina Health – Short Form Version
Download: Adobe PDF
Blue Cross and Blue Shield of Minnesota Version
Download: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Funeral Consumers Alliance Version
Download: Adobe PDF
Download: Adobe PDF
Information: Adobe PDF
Honoring Choices Minnesota – 4 Page Version
Download: Adobe PDF
Guide: Adobe PDF
Honoring Choices Minnesota – 8 Page Version
Download: Adobe PDF
Guide: Adobe PDF
Honoring Choices Minnesota – Large Font Version
Download: Adobe PDF
Short Form: Adobe PDF
Honoring Choices Minnesota – Short Form Version
Download: Adobe PDF
Download: Adobe PDF
Minnesota Legal Services Coalition Version
Download: Adobe PDF
Minnesota State Bar Association Version
Download: Adobe PDF
Download: Adobe PDF
University of Minnesota Version
Download: Adobe PDF
In Spanish: Adobe PDF
Multilingual Versions (7)
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Long Form: MS Word (.docx)
Download: Adobe PDF
Long Form: MS Word (.docx)
Download: Adobe PDF
Long Form: MS Word (.docx)
Download: Adobe PDF
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