Oklahoma Living Will Template
This Living Will is designed to reflect the desires and directives regarding medical treatment of the undersigned, specifically in accordance with the Oklahoma Advance Directive Act of 1992. This document allows you to declare your wishes concerning medical treatment in the event that you become unable to communicate your medical care decisions.
Part I: Information of the Principal
Full Name: ___________________________________________
Date of Birth: ________________________________________
Social Security Number: ________________________________
Address: _____________________________________________
City: ____________________ State: OK Zip Code: ___________
Part II: Directive Regarding Life-Sustaining Treatment
I, __________________________ (insert your name), being of sound mind, willfully, and voluntarily declare my desire that my dying shall not be artificially prolonged under the circumstances set forth below. If at any time I am unable to make my own healthcare decisions and am diagnosed to be in a terminal condition or in a persistently unconscious state by two licensed physicians, one of whom is my attending physician, I direct that the following marked expression of my directions be followed:
Part III: Directive Regarding Artificially Administered Nutrition and Hydration
I further declare that if I am in a terminal condition or a persistently unconscious state and where the likely risks and burdens of artificially administered nutrition and hydration outweigh the potential benefits:
Part IV: Signature of Principal
Signature: _______________________________ Date: ______________
This document is signed voluntarily and without any coercion or undue influence.
Part V: Witness Statement
We, the undersigned, declare that the principal is known to us, signed or acknowledged this Oklahoma Living Will in our presence, appears to be of sound mind, and under no duress, fraud, or undue influence. We are not related by blood or marriage to the principal, entitled to any portion of the estate of the principal, directly financially responsible for the principal’s medical care, or named as the principal’s healthcare proxy or as an alternate healthcare proxy.
Name of Witness 1: ___________________________________
Signature: _______________________________ Date: ______________
Name of Witness 2: ___________________________________
Signature: _______________________________ Date: ______________
This document should be kept in a place where it can be easily accessed by family members and healthcare providers. Consider providing copies to your healthcare proxy (if you have designated one), immediate family members, and your doctor.