INSTRUCTIONS: MONTANA ADVANCE DIRECTIVE PACKET

To file an advance directive documenting your wishes for health care in the event you are incapable of expressing them, you may file an advance directive. This is available as part of a packet from the website maintained by the Montana Department of Justice. The actual directive begins on the eleventh page of the packet.

Montana Advance Directive Packet Step 1: On the first blank line, enter your full name.

Montana Advance Directive Packet Step 2: Section 1 concerns steps to be taken if you are in a terminal condition and physician concludes you will die in a relatively short time without life sustaining treatment which only prolongs the dying process. Check all boxes next to statements expressing your wishes.

Montana Advance Directive Packet Step 3: Section 2 allows you to document a chronic illness or serious disability that should not be mistaken for a terminal condition. Completion of this section is optional.

Montana Advance Directive Packet Step 4: Section 3 allows you to appoint someone with power of attorney to make health care decisions on your behalf if you are unable to. Indicate with a check mark whether you wish to appoint a health care representative.

Montana Advance Directive Packet Step 5: If you wish to appoint a health care representative, print their full name on the first blank line of section A. Below, provide their address, home phone number and work phone number.

Montana Advance Directive Packet Step 6: In Section B, you may document up to two additional health care representatives.

Montana Advance Directive Packet Step 7: Section 4 requires your signature and that of up to two witnesses. Alternately, you may choose to have this form witnessed by a notary public. On the first three blank lines of Section A, enter the date, month and year.

Montana Advance Directive Packet Step 8: On the next blank line, enter your signature.

Montana Advance Directive Packet Step 9: On the next blank line, print your name.

Montana Advance Directive Packet Step 10: On the next three blank lines, enter your street address, city, state, zip code, home phone number and work phone number.

Montana Advance Directive Packet Step 11: Have witnesses complete Section B or have a notary public complete Section C.

Montana Advance Directive Packet Step 12: Special directions may be expressed in Section 5 on the last page.