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New Hampshire Advance Directive and Disclosure Statement

The health care agent acts after the required determination that the principal lacks capacity to make health care decisions.

Jurisdiction
New Hampshire
Purpose
Medical & health care
Source / form version
Seventeen-page guide linked in 2024; form reflects July 30, 2021 statutory changes
Resource format
PDF
Signing
Sign in the physical presence of two qualified witnesses, a notary public, or a justice of the peace. Witness relationship, inheritance and care-provider restrictions apply.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Download the guide with its disclosure

The Foundation’s complete packet includes planning guidance, the advance-directive disclosure, and the durable health care power of attorney and living will. New Hampshire requires the disclosure to accompany the directive. Keep it with the signed form instead of downloading only the three-page appointment and signature extract.

Sources: [1] [4] [2] [3]

Name an agent and explain your wishes

The form names a primary agent and alternate, with space to limit authority or add instructions. Multiple listed people serve in the stated order unless you provide a different arrangement. The living-will section records choices about life-sustaining treatment and situations you would consider excessively burdensome. Make those choices yourself after discussing their meaning with your clinician and the person who will speak for you.

Sources: [1] [4] [2] [3]

Arrange qualified witnesses or acknowledgment

Two-witness execution is an alternative to a notary or justice of the peace. Witnesses cannot be the agent, spouse, an heir or other expected estate recipient, or the attending practitioner or a person under that practitioner’s control; only one may be employed by a health or residential care provider. The signature section confirms that you received and understood the disclosure. Preserve additional pages, give complete copies to your agent and providers, and use separate medical orders if you want a DNR or POLST.

Sources: [1] [2] [3]

Common questions

Can I use the short form without its disclosure statement?

The statute requires the disclosure to accompany the advance directive. The complete guide includes it; retain the disclosure with the appointment and signature pages.

Sources: [2] [1]

Related forms and guides

Sources and verification

  1. Foundation for Healthy Communities: source and instructions (opens in a new tab)
  2. Signing and legal requirements (opens in a new tab)
  3. Authority and statutory guidance (opens in a new tab)
  4. Foundation for Healthy Communities: complete document (opens in a new tab)

Web PDF inspected:17pages including two-page disclosure and three-page form. Direct automated fetch403 on retry; published PDF accessible to the web reader. Three-page standalone fillable2024PDF omitted the accompanying disclosure and was not selected as the sole download.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.