Free Nebraska Advance Directive Form (Medical POA & Living Will) | PDF

Nebraska Advance Directive Form (Medical POA & Living Will)

The Nebraska Advance Directive signifies a prearranged compilation designed to record a person’s wishes regarding health care. The document comprises a living will and a power of attorney for health care and allows the declarant to proclaim medical treatment preferences should they become incapacitated.

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Last updated February 19th, 2026

The Nebraska Advance Directive signifies a prearranged compilation designed to record a person’s wishes regarding health care. The document comprises a living will and a power of attorney for health care and allows the declarant to proclaim medical treatment preferences should they become incapacitated.

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This document contains the following sections:

Part I: Power of Attorney for Health Care
Part II: Living Will Declaration

Laws

Statutes – Nebraska Revised Statutes – Power of Attorney for Health Care (§ 30-3401 – 30-3432) and Nebraska Revised Statutes – Rights of the Terminally Ill Act (§ 20-401 – 20.416)

Definition – “Power of attorney for health care” shall mean a power of attorney executed in accordance with sections § 30-3401 to § 30-3432, which authorizes a designated attorney-in-fact to make health care decisions for the principal when the principal is incapable (§ 30.3402).

Signing Requirements – To confirm the enforceability of the contract, corroboration by either a notary official or two (2) witnesses must be received upon the moment of endorsement. Nebraska state regulation further specifies that the witnessing parties must meet the specifications set forth in the Nebraska Revised Statutes § 30-3405 (§ 30-3404(5)).

Revocation – § 30-3420 and § 20-406

Other Versions (9)

AARP (Caring Connections)
Avera Health
Bryan Medical Center
Five Wishes (Aging with Dignity)
Kimball Health Services
Nebraska Catholic Conference
Nebraska Medicine
Prepare for Your Care
Spanish Version

AARP (Caring Connections) Version

Download: Adobe PDF
Instructions: Adobe PDF

Avera Health Version

Download: Adobe PDF

Bryan Medical Center Version

Download: Adobe PDF
Information: Adobe PDF

Five Wishes (Aging with Dignity) Version

Download: Adobe PDF
Information: Adobe PDF

Kimball Health Services Version

Download: Adobe PDF
Information: Adobe PDF

Nebraska Catholic Conference Version

Download: Adobe PDF
Information: Adobe PDF

Nebraska Medicine Version (also available in Spanish/en Español)

Download: Adobe PDF
Information: Adobe PDF

Prepare for Your Care Version (also available in Spanish/en Español)

Download: Adobe PDF

Spanish Version

Download: Adobe PDF

Additional Resources

Boone County Health Center – Advance Directives in Nebraska Guide
Gold Crest Retirement Center – Advance Directives
Memorial Community Health – Patient’s Rights to Make Health Care Decisions in NE
Memorial Health Care Systems – Advance Directives
Nebraska Department of Health and Human Services – Advance Directives Brochure
Nebraska Department of Health and Human Services – Mental Health Advance Directive FAQs
Nebraska Medicine – Set Up a Living Will or Power of Attorney
Nebraska Organ Recovery – Organ Donation
Nebraska Total Care – Advance Directives
University of Nebraska-Lincoln – Advance Directives Guide
University of Nebraska-Omaha – Living Wills and Advance Directives for Medical Decisions
Whitmore Law Office – Health Care Directives

Related Forms (5)

Advance Directive Wallet Card
Durable (Financial) Power of Attorney Form
Emergency Treatment Declaration
Physician’s DNR Order
Psychiatric Advance Directive

Advance Directive Wallet Card

Download: Adobe PDF

Durable (Financial) Power of Attorney

Download: Adobe PDF

Emergency Treatment Declaration (also available for a Minor)

Download: Adobe PDF
Information: Adobe PDF

Physician’s Do-Not-Resuscitate (DNR) Order

Download: Adobe PDF

Psychiatric Advance Directive

Download: Adobe PDF
Information: Adobe PDF

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