Instructions – Adobe PDF
Laws
Definitions – “Advance directive” means a written record executed pursuant to section 9703 of this title, which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document (18 V.S.A. § 9701(1)).
Signing Requirements – Acknowledgment of the agreement’s execution must be reviewed and verified by two (2) witnesses deemed viable by the state of Vermont (18 V.S.A. § 9703).
Revocation – 18 V.S.A. § 9704
Other Versions (5)
- AARP (Caring Connections)
- Five Wishes (Aging with Dignity)
- Prepare for Your Care
- Vermont Short Form
- Vermont Catholic
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Download: Adobe PDF
Instructions: Adobe PDF
Download: Adobe PDF
Instructions: Adobe PDF
Additional Resources
- Donate Life New England – Registry FAQ’s
- Grace Cottage Family Health & Hospital – Advance Directives
- Patient Choices Vermont – Guide to Advance Care Planning for Dementia
- University of Vermont Health Network – A Guide to Advance Directives
- Vermont Department of Health – Advance Directives
- Vermont Department of Health – Do Not Resuscitate (DNR)/COLST
- Vermont Ethics Network – Considering Medical Orders to Limit Treatment
- Vermont Ethics Network – Documenting Your Healthcare Decisions
Related Forms (6)
- Advance Directive Registration Agreement
- Advance Directive Wallet Card
- Appointment of a Health Care Agent
- Do Not Resuscitate (DNR/COLST) Order
- Durable (Financial) Power of Attorney Form
- Health Care Proxy
Advance Directive Registration Agreement
Download: Adobe PDF
Download: Adobe PDF
Appointment of a Health Care Agent
Download: Adobe PDF
Do Not Resuscitate (DNR/COLST) Order Form
Download: Adobe PDF
Instructions: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF
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