Montana Declaration - Regarding Decision by Attending Physician As To Administration of Life Sustaining Treatment
About this form
The Declaration Regarding Decision by Attending Physician As To Administration of Life Sustaining Treatment is a legal document that outlines your preferences regarding life support treatment when you are unable to communicate your wishes due to an incurable or irreversible health condition. This form is critical because it provides specific instructions to your physician, ensuring your healthcare decisions align with your values and desires, distinct from other advance directives like living wills or powers of attorney.
Main sections of this form
- Identification of the individual making the declaration.
- Specifications regarding the types of life-sustaining treatments to be administered or withheld.
- Signature of the individual to validate the declaration.
- Witness signatures or acknowledgment, depending on state requirements.
- Instructions for the attending physician based on current medical condition.
When to use this form
This form should be used when you want to ensure that your healthcare preferences are respected in situations where you are unable to communicate your desires. Common scenarios include severe medical conditions that result in a terminal diagnosis, persistent vegetative state, or other critical health situations where your ability to make decisions is compromised.
Intended users of this form
- Adults who want to clarify their wishes regarding life-sustaining treatment.
- Individuals with serious or chronic health conditions.
- Patients who are undergoing major surgeries or treatments where complications may arise.
- Anyone looking to provide guidance to healthcare providers in advance of a medical crisis.
Completing this form step by step
- Clearly state your full name and date of birth at the beginning of the form.
- Outline the specific life-sustaining treatments that you wish to accept or refuse.
- Sign and date the form to show your agreement and understanding.
- Have the form witnessed or notarized as required by your stateâs laws.
- Give copies to your healthcare providers and relevant family members to ensure your wishes are communicated.
Notarization guidance
This form does not typically require notarization unless specified by local law. Be sure to check your stateâs requirements to ensure the validity of the document.
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Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.
Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.
Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.
If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.
We protect your documents and personal data by following strict security and privacy standards.
Typical mistakes to avoid
- Failing to clearly specify the types of treatments you do or do not wish to receive.
- Not signing the document or overlooking signature requirements by witnesses.
- Neglecting to provide copies to healthcare providers, which can lead to confusion in emergencies.
- Not updating the form after significant health changes or personal circumstances.
Advantages of online completion
- Convenience of accessing legal forms from the comfort of your home.
- Editable templates that allow you to personalize your declarations according to your wishes.
- Reliability of having professionally drafted forms reviewed by licensed attorneys.
- Easy navigation and support for completing the form correctly.
Legal use & context
- The form is legally binding when executed according to state laws.
- It helps ensure that healthcare providers comply with your wishes regarding life-sustaining treatments.
- Limitations may apply based on state-specific regulations regarding medical directives.
What to keep in mind
- The declaration provides specific instructions on life-sustaining treatment preferences.
- Used primarily when the individual is incapacitated and unable to communicate.
- Ensure compliance with state-specific requirements for legal validity.
- Discuss your wishes with family and healthcare providers to promote understanding.
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FAQ
The California POLST form is valid in California. If you are traveling to another state, it is a good idea to take both your Advance Directive and your POLST form with you. Both documents, even if not legally binding, will help health care providers know your wishes. How can I find out more about POLST?
A POLST form is a legal document for people with an advanced progressive or terminal illnesses and specifies the type of care a person would like in an emergency medical situation.
Photocopies and FAXes of signed POLST forms are legal and valid. A copy should be retained in patient's medical record, on Ultra Pink paper when possible. Any incomplete section of POLST implies full treatment for that section.
How to Order the National POLST Form. Visit your program website or reach out to your program contact to order POLST forms (www.polst.org/map). Forms are not available to individuals since they are medical orders that should be completed by providers.
The DNR guides Emergency Medical Service (EMS) providers and can give EMS permission not to perform cardiopulmonary resuscitation (CPR), whereas a POLST might include a DNR instruction regarding CPR, but provides more instructions regarding additional medical interventions.
California has both an Advance Health Care Directive Form and a Physician Orders for Life Sustaining Treatment, POLST. An Advance Health Care Directive Form can be filled out by anyone over the age of 18 who wishes to document their care wishes; it must be signed by two witnesses or notarized in order to be valid.
A POLST form is a medical order that should be completed by your provider. Patients should not be provided a POLST form to complete on their own. A POLST form should never be completed without a conversation with the patient, or his/her surrogate, about diagnosis, prognosis, treatment options and goals of care.
