Medical Directives: Updates


NOTE: In 2022, added “Exceptions to Health care Directives” section to supplement explains withholding of life-sustaining health care in cases of incurable terminal illness or injury.

NOTE: In 2021, the “Designation of Health Care Agent” in each state’s supplement was revised to include “pecking order” information; also recommendation of two witnesses’ signatures as part of compliance with other states’ documents.

If you have any additional questions regarding the Medical Directive Statements, please contact us for help.




AL still requires principal and witnesses to be 19 years or older.


AK allows a notary public or 2 witnesses to verify principal’s signature.


  • Changed name from “Power of Attorney for Health Care” to “Durable Power of Attorney for Health,” as termed by AZ Attorney General. At least 1 witness or notary (CLR advises 2 witnesses); has health care registry which was moved to “Health Current”
  • AZ maintains a state registry which was checked for accuracy in Nov. 2020. Also, autopsy provision included. Information on “Do-Not-Resuscitate” form requirements included in supplement in Nov. 2020.


Updated form in Dec. 2020 that organ donation form must be signed by two witnesses or notarized. If choosing to have document witnessed, witnesses must be at least 18 years old. In addition, one of the witnesses may not be related by blood, marriage, or adoption, or entitled to any part of the estate under a will or by operation of law.


  • 2022: State registry available; verified for accuracy.
  • In Nov. 2020, changed document name to “Advance Health Care Directive.” State allows 2 witnesses or a notary public to verify signature. A state registry is also available.


Although witness signatures are not required, CLR advised in Nov. 2020 to have witnesses sign document to make it compliant with other states’ documents.


Changed to “health care representative” in Jan. 2021. From the form necessary to create your advance directive does not require the use of a notary. An additional optional form (witnesses’ affidavit) requires a notary public or a lawyer to verify the signature of the witnesses.


No additional updates.


  • 2022: CLR does not endorse one witness allowed to be a spouse or blood relative as it could invalidate the document in other states.
  • Witness statement was revised in Nov. 2020 using Florida Form 080111 of the FL Designation of Health Care Surrogate. At least one witness must not be a husband or wife or a blood relative of the principal.


Updated document in Dec. 2020 that witnesses do not have to be present when principal signs; burial disposition applies; non-mandatory designation of guardian.


No additional updates.


Idaho’s registry moved from the Secretary of State’s website to the Idaho Department of Health and Welfare. Registry is not available there as of 11/11/21.


  • 2022: Previous form required opening statement but any form could be used. The latest Statutory Short Form Power of Attorney (effective January 2018) states: “WHAT IF I DO NOT WANT TO USE THIS FORM? In the event you do not want to use the Illinois statutory form provided here, any document you complete must be executed by you, designate an agent who is over 18 years of age and not prohibited from serving as your agent, and state the agent’s powers, but it need not be witnessed or conform in any other respect to the statutory health care power. If you have questions about the use of any form, you may want to consult your physician, other health care provider, and/or an attorney.” Removing the opening statement and revising the POA to the standard one. Will include 2 witnesses’ signatures — rather than one — to meet other states’ requirements.
  • Although only one witness needs to sign document, CLR recommends 2 (because a second witness is required in many other states) — updated Dec. 2020


Changed name of document in Dec. 202 to Advance Directive; notary signature required when granting additional powers as an attorney-in-fact, per law.


Updated document in Nov. 2020 allowing either a notary public or 2 witnesses to verify signature.


Kansas requires 2 witnesses or a notary public to verify signature.


In Dec. 2020, changed name to “Advance Directive” because it includes the living will form.


No additional updates.


No additional updates.


In Dec. 2020, optional organ donation form with 2 witness signatures included with state document. In Nov. 2020, added to witness section: At least one of the witnesses must be someone who will not knowingly inherit anything from the principal or otherwise knowingly gain a financial benefit from the principal’s death.


“Massachusetts recognizes Health Care Proxies but there is no law in Massachusetts governing Living Wills and there is no standard Living Will form for Massachusetts. You can create your own or use the one we created below. Again, this is not legally valid but it can guide your Health Care Proxy and your physicians about the types of choices you would make.” (


MI has acceptance designation requirement on form for advocates; updated document and supplement in Nov. 2020. Revised form to allow both the primary and the secondary advocates to sign directive; updated document and supplement in Oct. 2021.


  • In Jan. 2022, changed name from “Durable Power of Attorney for Health Care” to “Health Care Directive”
  • MN allows a notary public or 2 witnesses to verify principal’s signature (no more than 1 witness can be a health care provider); updated document and supplement in Nov. 2020.


MS allows a notary public or 2 witnesses to verify principal’s signature.


Updated document in Jan. 2021 that a notary public is required under specific choices made in the document. Otherwise, two witnesses required in case of cremation authorization, etc. We advise notary public and witnesses to sign verifying principal’s signature.


In Dec. 2020 changed statement from health care agent to health care representative. Montana has registry which was checked for accuracy.


According to the Nebraska Department on Aging: The Rights of the Terminally Ill Act defines an adult as someone who is 19 years of age or older, or who has been married. Only an adult can sign an advanced directive.


State requires 2 witnesses or a notary public to verify signature; state has registry and website was verified for accuracy in Nov. 2020. State-authorized forms use “agent” (not “attorney-in-fact”) which were changed in Dec. 2020.

New Hampshire

Updated document in Dec. 2020, that 2 witnesses, notary public, or justice of the peace can witness principal’s signature. Also added a disclosure statement at the front of the document.

New Jersey

Updated document in Dec. 2020 that New Jersey has brain death provision; can have witnesses or notary, attorney, or other to sign as witness.

New Mexico

Although two witnesses’ signatures are not required, CLR advised in Dec. 2020 to have two witnesses sign document to make it compliant in other states.

New York

Organ donation issues involving health care agent apply — updated Dec. 2020.

North Carolina

  • 2022: North Carolina has a registry. Checked website for accuracy.
  • In Jan. 2021, CLR changed document to “Health Care Power of Attorney”; principal’s signature and 2 witness signatures must be notarized.

North Dakota

No additional updates.


  • 2022: Organ donation registry website checked for accuracy.
  • In Dec. 2020, CLR advised the naming of an alternate agent despite the state’s requirement of only one name. CLR used text from the law at the beginning of the document so that it is in uniformity with their witness requirements.


No additional updates.


CLR has not updated Oregon’s DPOA since 2018.


No additional updates.

Rhode Island

No additional updates.

South Carolina

In Jan. 2021, document revised that principal’s signature and 2 witnesses’ signatures must be notarized.

South Dakota

No additional updates.


Tennessee requires 2 witnesses or a notary public to verify signature.


Disclosure statement required at beginning of document; 2 witnesses or notary can witness signature; can designate a second alternate agent. Updated with these changes in Dec. 2020.


Although Utah allows 1 witness to verify principal’s signature, CLR recommends 2 witnesses’ signatures to comply with other states’ documents.


In Jan. 2021, document name changed from “Durable Power of Attorney” to “Advance Directive”; updated that an extra witness is needed if the principal is in the hospital or being admitted to a hospital or care facility. Vermont has state registry — checked for accuracy.


Virginia has state registry for DPOAs; updated website information.


  • Revised this year’s form re: RCW 11.125.050: Signature must be witnessed by 2 qualified adults or by notary requirement (previously was not mandatory)
  • Although witness signatures are not mandatory, CLR advised in Dec. 2020 to have 2 witnesses sign document to make it compliant with other states’ documents.

Washington DC

No additional updates.

West Virginia

In Jan. 2021, document revised that principal’s signature and 2 witnesses’ signatures must be notarized.


In Feb. 2020, incapacity designation found on page 2 of the document was changed to include nurse practitioners and physician assistants.


No additional updates.

Alberta – Canada

Document can be registered with government; information added to 2022 supplement.

British Columbia – Canada

In Feb. 2021, CLR added information about a temporary substitute decision maker.

Ontario – Canada

No additional updates.

CLR revises the documents each year. If you have a previous version of the document it is still valid; however, you may want to download and sign the newest version in the event any laws have changed specific to your situation or condition.