New Mexico Living Will Template
This Living Will is created in accordance with the New Mexico Uniform Health Care Decisions Act. It allows individuals to express their wishes regarding medical treatment in the event that they become unable to communicate those wishes themselves.
Personal Information
Name: __________________________________________
Date of Birth: ___________________________________
Address: ________________________________________
City, State, Zip Code: __________________________
Declaration
I, the undersigned, being of sound mind, voluntarily make this declaration to provide guidance regarding my medical treatment in the event that I am unable to make decisions for myself.
Medical Treatment Preferences
If I am diagnosed with a terminal condition or am in a persistent vegetative state, I wish for the following preferences to be considered:
- 1. I do not want life-sustaining treatment if it only prolongs the process of dying.
- 2. I wish to receive comfort care to alleviate pain and suffering.
- 3. I would like to be kept as comfortable as possible, even if it hastens my death.
- 4. I do not want artificial nutrition and hydration if I cannot swallow.
Appointment of Health Care Agent
If I am unable to make my own medical decisions, I designate the following person to act as my health care agent:
Name of Health Care Agent: ______________________________
Address: _____________________________________________
Phone Number: ________________________________________
Signature
I hereby declare that I am of legal age and that I understand the contents of this Living Will. I sign this document voluntarily and without any undue influence.
Signature: ___________________________________________
Date: _______________________________________________
Witnesses
This Living Will must be signed in the presence of two witnesses who are not related to me and who are not entitled to any portion of my estate.
Witness 1 Name: _____________________________________
Witness 1 Signature: _________________________________
Date: _______________________________________________
Witness 2 Name: _____________________________________
Witness 2 Signature: _________________________________
Date: _______________________________________________
Notarization (optional)
This document may also be notarized for additional validity.
State of New Mexico
County of ___________________________________________
Subscribed and sworn to before me this _____ day of __________, 20__.
Notary Public: ______________________________________
My Commission Expires: _____________________________