Advance Directive (VA)

This questionnaire helps you create a Virginia Advance Medical Directive. The form includes five "Options" (or parts):

  • Options I & II: Appointment of Health Care Agent lets you name someone to make decisions about your medical care if you can no longer speak for yourself, including decisions about life support. You can also choose the powers that your agent will have while making health care decisions for you.
  • Option III: Health Care Instructions lets you record instructions for the health care you want to receive or do not want to receive in certain situations.
  • Option IV: End of Life Instructions lets you say if you want life-sustaining procedures if you become terminally ill, are in a persistent vegetative state, or enter into an end-stage condition.
  • Option V: Anatomical Gift lets you record your wishes about organ donation and appoint an agent to make any such anatomical gift or organ, tissue, or eye donation after your death.

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Advance Directive - Virginia (Guidance Notes)