Pennsylvania Advance Directive Form (Medical POA + Living Will)

A Pennsylvania advance directive is a set of instructions that informs medical agents and providers about how to handle a person’s medical care should they be unable to speak for themselves. A “living will” lists treatments that the individual would like to accept or refuse, and a “medical power of attorney” assigns a spokesperson (usually a trusted friend or family member) to make healthcare-related choices when the individual does not have the capacity to choose for themselves.

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What’s Included?


Signing Requirements (20 PA Cons Stat § 5442(b)) – Two (2) witnesses ages eighteen (18) and older. Witnesses may not be the principal’s health care provider.

State Definitions

  • Advance Health Care Directive (20 PA Cons Stat § 5422) – A health care power of attorney, living will or a written combination of a health care power of attorney and living will.
  • Health Care Agent (20 PA Cons Stat § 5422) – An individual designated by a principal in an advance health care directive.
  • Health Care Power of Attorney (20 PA Cons Stat § 5422) – A writing made by a principal designating an individual to make health care decisions for the principal.
  • Living Will (20 PA Cons Stat § 5422) – A writing made in accordance with this chapter that expresses a principal’s wishes and instructions for health care and health care directions when the principal is determined to be incompetent and has an end-stage medical condition or is permanently unconscious.
  • Principal (20 PA Cons Stat § 5422) – An individual who executes an advance health care directive, designates an individual to act or disqualifies an individual from acting as a health care representative or an individual for whom a health care representative acts in accordance with this chapter.

Versions (5)

Allegheny County

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Guthrie Medical Group

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Lancaster General

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blankPennsylvania Catholic Conference

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