Colorado Living Will Template
This Living Will is designed to reflect the directives concerning the health care decisions of the undersigned. It is created in accordance with the Colorado Medical Treatment Decision Act, ensuring that the specified preferences are honored in situations where the individual is unable to make informed decisions regarding their medical care.
Part I: Personal Information
Full Name: ________________________________________________________
Date of Birth: _________________________
Address: ____________________________________________________________
City: _____________________ State: Colorado Zip: ____________________
Telephone Number: _____________________
Part II: Health Care Directives
In the event that I, ________________ [Full Name], become incapacitated and am unable to actively participate in my healthcare decisions, I hereby declare my wishes as follows:
- Life-Sustaining Treatment: In situations where my recovery is uncertain and I am unable to make decisions for myself, I direct that:
- All life-sustaining treatments be withheld or withdrawn if I am in a persistent vegetative state, have a terminal condition, or am in a state of irreversible coma.
- Nutritional and hydration support may be withheld or withdrawn if it only prolongs the process of dying and cannot help me to recover.
- Pain Management and Comfort Care: I wish to receive treatment that eases pain and suffering, even if it does not prolong my life, ensuring my comfort and maintaining my dignity.
- Specific Treatments: I have the following specific wishes regarding my care:
______________________________________________________________
______________________________________________________________
Part III: Designation of Health Care Agent
I designate the following individual as my Health Care Agent to make health care decisions for me in the event that I am incapable of making such decisions:
Name of Agent: ______________________________________________________
Relationship: ________________________________________________________
Address: ____________________________________________________________
City: ______________________ State: Colorado Zip: ____________________
Telephone Number: ___________________________________
If my initially appointed Health Care Agent is unable, unwilling, or unavailable to serve, I designate the following individual as an alternate agent:
Name of Alternate Agent: _____________________________________________
Relationship: ________________________________________________________
Address: ____________________________________________________________
City: ______________________ State: Colorado Zip: ____________________
Telephone Number: ___________________________________
Part IV: Signatures
This Living Will shall remain in effect until I revoke it. No health care provider, my agent, nor any other individual stands to benefit financially from my death due to decisions made under this Living Will. I understand the full import of this document and I am emotionally and mentally competent to make this Living Will.
Signature: _______________________________ Date: _________________
In the presence of (Witness or Notary):
Witness 1 Signature: _______________________________ Date: _________________
Witness 1 Printed Name: _________________________________________________
Witness 2 Signature: _______________________________ Date: _________________
Witness 2 Printed Name: _________________________________________________
Declaration of Witnesses
We, the undersigned witnesses, declare that the signer of this Colorado Living Will is known to us, signed this will willingly and free from undue influence, and appeared to us to be of sound mind and aware of the nature of this document and its significance at the time of signing.