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Form #707California Declaration
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California.Â
DECLARATION
If I should have an incurable and irreversible
condition that has been diagnosed by two physicians and that will result in my
death within a relatively short time without the administration of
life-sustaining treatment or has produced an irreversible coma or persistent
vegetative state, and I am no longer able to make decisions regarding my
medical treatment, I direct my attending physician, pursuant to the Natural
Death Act of California, to withhold or withdraw treatment, including
artificially administered nutrition and hydration, that only prolongs the
process of dying or the irreversible coma or persistent vegetative state and is
not necessary for my comfort or to alleviate pain.
If I have been diagnosed as pregnant, and that
diagnosis is known to my physician, this declaration shall have no force or
effect during my pregnancy.
Signed this _________ day of _________, _________.
Signature
_________
Address _________
The declarant voluntarily signed this writing in my
presence. I am not a health care provider, an employee of a health care
provider, the operator of a community care facility, an employee of an operator
of a community care facility, the operator of a residential care facility for
the elderly, or an employee of an operator of a residential care facility for
the elderly.
Witness
_________
Address _________
The declarant voluntarily signed this writing in my
presence. I am not entitled to any portion of the estate of the declarant upon
his or her death under any will or codicil thereto of the declarant now
existing or by operation of law. I am not a health care provider, an employee
of a health care provider, the operator of a community care facility, an
employee of an operator of a community care facility, the operator of a
residential care facility for the elderly, or an employee of an operator of a
residential care facility for the elderly.
Witness
_________
Address _________
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These forms are provided to assist business owners and others in understanding important
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that no legal advice, accounting, or other professional service is being offered
by these documents or on this website. Laws vary in the different states. Agreements
acceptable in one state may not be enforced the same way under the laws of another
state. Also, agreements should relate specifically to the particular facts of each
situation. Therefore, it is important to consult legal counsel whenever utilizing
these forms. The Forms are not a substitute for legal advice YourFreeLegalForms.com
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Keywords: California, Declaration, will, wills, legal forms
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