Get the free Revocation of Life Prolonging Procedures Declaration

This document serves as a written revocation of a previously executed Life Prolonging Procedures Declaration, allowing the declarant to revoke their decision regarding life prolonging procedures at

How to fill out revocation of life prolonging

How to fill out Revocation of Life Prolonging Procedures Declaration

1. Obtain the Revocation of Life Prolonging Procedures Declaration form from a trusted source.
2. Read the instructions carefully to understand the implications of the declaration.
3. Fill in your personal information such as name, address, and date of birth.
4. Clearly state your decision to revoke any previously made advance directives or life-prolonging procedures.
5. Sign and date the form in the presence of a witness or notary, as required by your jurisdiction.
6. Provide copies of the completed form to your healthcare provider and keep a copy for your records.

Who needs Revocation of Life Prolonging Procedures Declaration?

1. Individuals who have previously created an advance directive.
2. People who wish to change their healthcare preferences regarding life support.
3. Patients in situations where their medical decisions may change over time.
4. Anyone who wants to ensure their current wishes are legally documented and respected.

This form is a revocation of Form IN-P024 which provides for a person's wishes and desires regarding whether his/her life is prolonged by artificial means. Specific reference is made to the earlier executed Declaration.

People Also Ask about

What is a declaration relating to life-sustaining procedures?

A declaration relating to use of life-sustaining procedures will be given effect only when the declarant's condi- tion is determined to be terminal or the declarant is in a state of permanent unconsciousness, and the declarant is not able to make treatment decisions.

What is a life-sustaining procedure?

Life-sustaining treatment is defined as mechanical ventilation, renal dialysis, chemotherapy, antibiotics, and artificial nutrition and hydration.

How to write an advance directive?

In California, advance directives are the legally recognized format for “living wills.” An advance directive enables individuals to make sure that their health care wishes are known in advance and considered if for any reason they are unable to speak for themselves.

What is the life-sustaining process?

Life-sustaining treatment: Any medical procedure or intervention which utilizes mechanical or other artificial means to sustain or replace a vital function essential to the life of the patient (e.g., mechanical ventilation, medically assisted nutrition and hydration, vasopressors and/or inotropes).

What is a declaration of life?

This is a written declaration stating your wishes regarding the use of any life-prolonging medical treatment.

Is a polst the same as a living will?

Preparing an Advance Directive Get the living will, Opens dialog and medical power of attorney, Opens dialog forms for your state. Choose someone to be your health care agent, Opens dialog. Fill out the forms, and have them notarized or witnessed as your state requires.

Is a declaration the same as a living will?

A living will, also called a declaration, tells your family and doctor your wishes when you can't speak for yourself. It's used to describe treatment you want as you near the end of your life or if you get seriously hurt or ill. You can change or cancel your living will at any time.

For pdfFiller’s FAQs

What is Revocation of Life Prolonging Procedures Declaration?

The Revocation of Life Prolonging Procedures Declaration is a legal document that allows an individual to withdraw their consent for life-sustaining procedures if they are unable to communicate their wishes in a medical setting.

Who is required to file Revocation of Life Prolonging Procedures Declaration?

Individuals who wish to revoke their prior decisions regarding life-prolonging treatments are required to file the Revocation of Life Prolonging Procedures Declaration.

How to fill out Revocation of Life Prolonging Procedures Declaration?

To fill out the Revocation of Life Prolonging Procedures Declaration, individuals must complete the form by providing personal information, detailing their previous wishes regarding life-prolonging treatment, and signing the document in the presence of witnesses or a notary as required by local laws.

What is the purpose of Revocation of Life Prolonging Procedures Declaration?

The purpose of the Revocation of Life Prolonging Procedures Declaration is to ensure that an individual's healthcare preferences regarding life-sustaining treatments are respected even if they are unable to communicate those preferences at a later time.

What information must be reported on Revocation of Life Prolonging Procedures Declaration?

The Revocation of Life Prolonging Procedures Declaration must report personal identifying information of the individual, details of the previous advance directive being revoked, and the date of the revocation along with the signatures of the individual and witnesses.