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) VersionAdobe PDF

What’s Included?


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)


Download: Adobe PDF






Download: Adobe PDF





Fairmont Regional Medical Center

Download: Adobe PDF





blankGrant Memorial

Download: Adobe PDF





blankWest Virginia Ethics Commission

Download: Adobe PDF