Montana > Statewide > Living Will
Declaration (Living Will - Designating Other) - Montana
| Declaration (Living Will - Designating Other) Form. This is a Montana form and can be used in Living Will Statewide . |
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A declaration that designates another individual to make decisions governing the withholding OI withdrawal of life-sustaining treatment may, but need not, be in the following form: DECLARATION If I should have an incurable and irreversible condition that, without the administration of life- sustaining treatment, will, in the opinion of my attending physician, cause my death within a relatively short time and I am no longer able to make decisions regarding my medical treatment, I appoint or, if he or she is not reasonably available or is unwilling to serve, , to make decisions on my behalfregarding withholding or withdrawal of treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain, pursuant to the Montana Rights ofthe Terminally 111 Act. If the individual I have appointed is not reasonably available or is unwilling to serve, I direct my attending physician, pursuant to the Montana Rights of the Terminally Ill Act, to withhold or withdraw treatment that only prolongs the process of dying and is not necessary for my comfort or to alleviate pain. Signed this- day of ,20- NXIX Address The de&rant voluntarily signed this document in my presence. Witness Name Address Witness Name Address Name and address of designee: NZUne Address
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