No specific form is required. You can have an attorney prepare an advance directive for you or you can do it yourself using one of these forms. We offer a long form and a short form. The short form is simpler, while the long form gives more detailed instructions.

Use our Advance Directive for Health Care short form (three pages).

• Use the fillable PDF version of the Advance Directive short form.
• Use the web page version of our Advance Directive short form.

Or use our Advance Directive for Health Care long form (11 pages).

• Use the fillable PDF version of the Advance Directive long form.
• Use the web page version of our Advance Directive long form.

Once your advance directive is drafted and you are satisfied with its contents, you must sign the advance directive in front of two witnesses who are not your agent or immediate family members. Your immediate family includes your spouse or partner, your parents, your siblings, your children or grandchildren.

Your witnesses must also sign the document. It does not need to be notarized.

You can pick any adult who has the ability to make decisions about your care to be your agent, except your doctor or health care provider. You should pick someone you trust and who knows you well.

The person you appoint as your agent gets the authority to do a number of things on your behalf:

1. get copies of your medical and hospital records
2. agree to or refuse medical treatment for you
3. participate in any meetings about what health care you should get
4. consent to the disclosure of your medical records
5. file a complaint on your behalf if there is a problem with your treatment

A health care advance directive does not give your agent authority to handle your money or make sure your bills are paid. You need a different document if you want to give someone authority to handle your money. That document is called a Power of Attorney.

In addition, a health care agent can never agree for you to be sterilized.

When you have an agent, you still have the right to make your own health care decisions. The agent is only allowed to help make sure your wishes are followed. If your agent disagrees with what you want, you win. As long as you are able to express your wishes, your doctors and medical providers must do what you say, not what your agent says.

There is one exception to this rule. Sometimes people with a mental illness or anticipating dementia want to lock in decisions for themselves now, when they are mentally healthy, even if they think they will want to make a different decision later. They can plan for this if they follow all the legal requirements. For more information on this possibility, see Part 6 of the Vermont Ethics Network’s Advance Directive (long form).

Give a copy of your advance directive to the person you picked as your agent. Talk with your agent about what you have written and what you want for medical treatment. You may also want to give a copy to other family members so they know about it.

Give a copy of your advance directive to your doctor and to any nursing home, hospital or other place you may get medical care.

If you have a serious medical condition, ask your doctor or other clinician whether you need a DNR/COLST. If you want, talk to your doctor about getting DNR identification such as a bracelet or necklace. Such IDs will be honored by medical personnel only if bought from a state approved seller.

The Vermont Department of Health can store your advance directive in an online registry. The registry is free. Doctors and hospitals are required to check the registry, so that is a good way to make sure that they will know about your advance directive. You can submit your advance directive to the registry by mail or fax. This is a free service for Vermonters.

You may change or revoke (withdraw or cancel) your advance directive at any time. The best way to change it is to write a new advance directive. After you write the new advance directive, you should give it to all the people and organizations that have the old one. You should tell them that you revoked the old one.

Review your advance directive periodically (at least once a decade) and when things in your life change, such as divorce, death of a loved one, serious diagnosis or deterioration. These are sometimes referred to as the “5 D’s.”