The New Hampshire Advance Directive is the standardized paperwork designed to officially recognize defined selections regarding an individual’s medical preferences. The form is provided as a formal conveyance of desires, recorded ahead of time in case health issues should arise, leaving the patient unable to communicate their wishes. The agreement seeks to identify a designated agent to make decisions should the principal party become incapacitated. It additionally outlines possible scenarios with space for the declarant to indicate their choices for a potential course of action.
This document contains the following sections:
- Part I: Durable Power of Attorney for Health Care
- Part II: Living Will
Laws
Definition – “Advance directive” means a directive allowing a person to give directions about future medical care or to designate another person to make medical decisions if he or she should lose the capacity to make health care decisions. The term “advance directives” shall include living wills and durable powers of attorney for health care (§ 137-J:2(I)).
Signing Requirements – Either a notary public must confirm the signing of the agreement or two acceptable (2) witnesses as directed by the New Hampshire State Statutes § 137-J:14(a).
Revocation – § 137-J:15
Other Versions (6)
- AARP (Caring Connections)
- Catholic Diocese of Manchester
- Five Wishes (Aging with Dignity)
- Foundation for Healthy Communities
- Prepare for Your Care
- Well Sense Health
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Catholic Diocese of Manchester Version (also available in Spanish/en Español)
Download: Adobe PDF
Information: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
New Hampshire Foundation for Healthy Communities 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
Download: Adobe PDF
Additional Resources
- Ansell & Anderson Trust and Estate Law – Advance Directives for Health Care
- Catholic Diocese of Manchester – End-of-Life-Care/Three Beliefs
- Catholic Diocese of Manchester – Three Beliefs Guide (also available in Spanish/en Español)
- Dartmouth-Hitchcock Health – Advance Care Planning
- NRC-PAD – New Hampshire FAQs
- NH Foundation for Health Communities – Advance Care Planning Guide (also available in Spanish/en Español)
- NH Foundation for Health Communities – Advance Directives and DNR FAQs
- NH Foundation for Health Communities – POLST Brochure
- New Hampshire Judicial Branch – Making Medical Decisions for Someone Else Handbook
Related Forms (4)
- Advance Directive Wallet Card
- Durable (Financial) Power of Attorney Form
- Portable DNR Order
- POLST Form
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Portable Do Not Attempt Resuscitation (P-DNR) Order (also available in Spanish/en Español)
Download: Adobe PDF
Provider Orders for Life-Sustaining Treatment (POLST)
Download: Adobe PDF