Vermont Advance Directive for Health Care

Choose the sections you need

Vermont Ethics Network’s short form lets you appoint an agent and alternates, describe goals and treatment preferences, and record donation or disposition choices. You may complete only the parts you need, but the instructions say to cross out unused sections rather than remove pages. The signature section still needs to be completed.

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

Plan for facility signing rules

Two adult witnesses are required and cannot be the agent or specified close relatives. If you are a hospital patient or a resident of a nursing home or residential care home, an eligible person must also explain the document and affirm that explanation under Vermont’s facility safeguards. The packet identifies eligible explainers and the affirmation space. Arrange this with the facility in advance rather than assuming ordinary witness signatures alone are enough.

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

Keep registry paperwork separate

The download includes an optional Vermont Advance Directive Registry administration form. Registration helps authorized providers find a copy; it is separate from creating and signing the directive. The registry’s revocation selection closes a registration and does not itself revoke the health care directive. Keep the signed directive, send complete copies to agents and care providers, and follow the legal amendment or revocation process when your wishes change.

Sources: [1] [2] [3]

Related forms and guides

• Vermont Power of Attorney Forms
• Vermont General Financial Power of Attorney
• Medical Power of Attorney and Health Care Proxy Forms
• Medical vs. Financial Power of Attorney

Sources and verification

1. Vermont Ethics Network; registry materials from Vermont Department of Health: 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. Vermont Ethics Network; registry materials from Vermont Department of Health: complete document ↗ (opens in a new tab)

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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.