Vermont Advance Directive Form (Medical POA & Living Will)

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The Vermont Advance Directive assembles a comprehensive legal arrangement to allow an individual to express their wishes related to end-of-life care. The form is essentially the combination of two documents, a medical power of attorney and a living will. The registry provides an opportunity for the principal party to construct an extensive outline of desired treatment options. Additionally, a segment of the contract will serve to identify a selected agent to make health care decisions on behalf of the declarant, should they become incapacitated. The patient can record supplemental information to create a concrete understanding of what they would like to occur regarding pain management, hospice care, organ donation, and funeral arrangements. Once the filing is completed, registration of the event can be submitted by sending a copy of the finalized advance directive, along with the Advance Directive Registration Agreement to the following address or fax number:

By Mail:
Vermont Advance Directive Registry (VADR)
PO Box 2789
Westfield, NJ 07091-2789

OR

By Fax:

(908) 654-1919

Other Versions (5)

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

 

 

 


Short Form Version

Download: Adobe PDF
Instructions: Adobe PDF

 

 


Vermont Catholic Version

Download: Adobe PDF
Instructions: Adobe PDF

 

 

Additional Resources

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