Vermont Advance Directive Form (Medical POA + Living Will)

A Vermont advance directive is a legal document that allows an individual to list life-prolonging and other directives for medical providers should they experience an event of incapacitation. The form also involves the designation of a medical power of attorney who is given the authority to make healthcare decisions for the patient once a physician determines that the patient is no longer of sound mind.


Signing Requirements (18 V.S.A. § 9703) – The principal and two (2) or more witnesses at least eighteen (18) years of age.

State Definition (18 V.S.A. § 9701) – “Advance directive” means a written record executed pursuant to section 9703 of this title, which may include the appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. The term includes documents designated under prior law as a durable power of attorney for health care or a terminal care document.

Spanish (Español) VersionAdobe PDF

Versions (5)

Vermont Department of Health

Download: Adobe PDF





Vermont Ethics Network

Download: Adobe PDF





Vermont Legal Services

Download: Adobe PDF






Download: Adobe PDF





blankVermont Roman Catholic Diocese

Download: Adobe PDF