That My Dying Shall Not Be Artificially Prolonged Under The Circumstances Set Forth Below And Do Hereby Declare Form
Use a That My Dying Shall Not Be Artificially Prolonged Under The Circumstances Set Forth Below And Do Hereby Declare template to make your document workflow more streamlined.
What this declaration does
This declaration records a person’s wishes about life-sustaining treatment when illness or injury prevents direct decision-making. It may identify a health care agent, describe treatment preferences, and guide clinicians and family members. In the United States, its legal effect depends on state law, including required wording, witnesses, notarization, and delivery to the treating organization. ESIGN generally recognizes electronic records, but excludes wills and related testamentary documents and does not override state-specific execution rules. signNow can upload the form, detect fields, route copies, protect information, and preserve an audit trail; it does not determine legal validity.
Who uses this declaration and why
Healthcare providers
Healthcare providers use the declaration to record a patient’s treatment preferences, identify an authorized health care agent, and retain a readable copy for care coordination. HIPAA safeguards may apply when protected health information is handled, while state law determines witnesses, notarization, and execution requirements.
Individuals and families
Individuals and families use the form to communicate end-of-life treatment preferences, distribute copies to agents and clinicians, and preserve the signed record. The signer should verify state-specific requirements before treating an electronically completed copy as legally operative.
People and organizations using this form
A patient completing an advance-care plan can enter treatment preferences, name a health care agent, and distribute a readable copy to clinicians and family members. signNow helps organize the file and preserve execution evidence, but the patient must verify state-specific witness, notary, and electronic-signature rules before relying on it legally. A healthcare organization can use a controlled declaration template, route it to the patient and required participants, and retain the completed record with access restrictions. HIPAA safeguards and a business associate agreement may apply to protected health information, while state law determines whether the selected execution method is accepted.
How this declaration moves from draft to record
A living-will declaration requires legal review first; signNow can organize the document, identify fields, and preserve the resulting record for authorized recipients.
Check state rules: Confirm whether your state accepts electronic preparation or requires witnesses, notarization, or wet-ink execution. Complete the form: Enter treatment preferences, personal details, and agent information exactly as requested by the declaration. Prepare in signNow: Upload the document to signNow for field detection, review, and controlled distribution to authorized recipients. Finalize and store: Obtain any required signatures, witnesses, or notarization, then store the completed record with access controls.
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Steps for preparing the declaration
Use signNow to prepare and document the declaration, but confirm state-specific execution requirements before treating the completed file as legally effective.
Upload document:
Upload the declaration PDF to signNow. Check fields:
Review automatically detected fields manually. Assign participants:
Add authorized recipients and execution order. Check formalities:
Confirm state-required witnesses or notarization. Preserve record:
Export and securely store the completed record.
Features that support this declaration
signNow can organize, route, protect, and document this declaration workflow, while state law determines whether electronic execution is legally sufficient.
Field detection
Upload the declaration and review signNow’s automatically detected fields, correcting placement before anyone enters treatment preferences or signature information.
Signer routing
Route the declaration to the signer, health care agent, or other authorized participant in a controlled sequence that reflects the document’s execution plan.
Audit trail
Capture invitations, access, timestamps, and signer actions in an audit trail that can accompany the completed declaration for record review.
Data protection
Protect treatment preferences and health information with encryption in transit and at rest, plus access controls for authorized recipients.
Controlled templates
Use reusable templates for a state-approved declaration only after reviewing whether the template’s witnesses, notary section, and wording remain current.
Record preservation
Keep the completed declaration and supporting execution evidence together so clinicians and agents can locate an intelligible record when needed.
Security for sensitive health preferences
Encryption at rest:
Encryption in transit:
Independent certification:
Security certification:
Health data safeguards:
Record activity:
Best practices for completing this declaration
Accurate treatment instructions, state-law review, controlled access, and complete execution evidence help make this declaration usable when medical decisions become urgent.
Verify state execution rules
Review treatment instructions carefully
Confirm agent information
Preserve the complete record
Risks of improper completion
Invalid execution
State requirements unmet
Missing witnesses
Declaration may be rejected
Excluded document
ESIGN exception applies
Unclear preferences
Treatment intent disputed
Challenges when preparing this declaration
Incomplete medical preferences can leave physicians and family members uncertain about treatment decisions, especially when the declaration does not clearly address life-sustaining procedures. State-specific witness, notarization, or form-language requirements may prevent a declaration from being accepted even when the signer intended it to be legally effective. A stored copy may not reach the treating facility, appointed health care agent, or family member when an emergency requires immediate access. Using an electronic signature without checking state law can create uncertainty because wills and certain related documents are excluded from ESIGN and UETA.
Troubleshooting this declaration workflow
Resolve execution, privacy, and field-detection questions by separating signNow workflow capabilities from state-law requirements for advance medical directives.
A living-will declaration may fall outside the electronic-signature rules that apply to ordinary business records. ESIGN excludes wills and testamentary documents; state law controls whether this declaration may be signed electronically, witnessed, or notarized. Check the applicable state authority before relying on a signNow signature.
The signNow Business plan includes legally binding eSignatures, audit trails, templates, and mobile apps at $8 per user per month when billed annually. Those features do not override state witness, notarization, or health-care-document requirements, so confirm acceptance before sending.
If the declaration contains protected health information, signNow identifies HIPAA compliance as requiring a business associate agreement. Execute the BAA and limit access to authorized recipients; HIPAA does not determine whether a state accepts electronic execution.
A blank or misidentified field can result from an unusual PDF layout or scanned page. Review signNow’s detected fields manually, add missing initials, dates, or signature fields, and compare the completed document against the state-approved declaration before distribution.
Use the signNow audit trail to document invitations, signer actions, timestamps, and access events. For a declaration requiring witnesses or notarization, retain separate evidence of those steps because an audit trail alone does not satisfy every state execution rule.
The signNow Business Premium plan adds bulk send and kiosk mode, but neither feature establishes legal validity for a living-will declaration. Use a controlled, individual workflow unless counsel and the applicable state authority permit the selected signing method.
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