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Nebraska Living Will Form

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The Nebraska power of attorney for health care is one of the two basic types of advance directive in Nebraska.

Nebraska Living Will Form
Nebraska Living Will Form
Nebraska Living Will Declaration
If I should lapse into a persistent vegetative state or 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 direct my attending physician, pursuant to
the Rights of the Terminally Ill Act, to withhold or withdraw life-sustaining treatment that is not
necessary for my comfort or to alleviate pain.
Other directions: __________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
_____________________________________________________________________________
Signed this _____ day of ________________________
Signature _______________________________
Address _______________________________
_______________________________
The declarant voluntarily signed this writing in my presence.
Witness ________________________________
Address ________________________________
________________________________
________________________________
Witness ________________________________
Address ________________________________
________________________________
Or
The declarant voluntarily signed this writing in my presence.
____________________________________
Notary Public
Nebraska Living Will Form