West Virginia Advance Directive Form (Medical POA + Living Will)

A West Virginia advance directive is a document referenced by medical providers and created by patients that outlines the patient’s medical wishes involving end-of-life treatment and resuscitative efforts. Part of the form also includes the option to designate a medical power of attorney who is given the ability to make decisions for the patient in the event that they are incapacitated and cannot speak for themselves.

Spanish (Español) Version – Adobe PDF

What’s Included?

Laws

Signing Requirements (§ 16-30-4) – Two (2) witnesses and a notary public.

 State Definitions

  • Living Will (WV Code § 16-30-3(n)) – Living will” means a written, witnessed advance directive governing the withholding or withdrawing of life-prolonging intervention, voluntarily executed by a person in accordance with the requirements of §16-30-4 of this code.
  • Medical Power of Attorney Representative (WV Code § 16-30-3(q)) – “Medical power of attorney representative” or “representative” means a person, 18 years of age or older, appointed by another person to make health care decisions pursuant to the provisions of §16-30-6 of this code or similar act of another state and recognized as valid under the laws of this state.

Versions (5)


AARP

Download: Adobe PDF

 

 

 

 


Everplans

Download: Adobe PDF

 

 

 

 


Fairmont Regional Medical Center

Download: Adobe PDF

 

 

 

 


blankGrant Memorial

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blankWest Virginia Ethics Commission

Download: Adobe PDF