Virginia Advance Medical Directive FormVirginia Advance Medical Directive FormVirginia Advance Medical Directive Form
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I, ______________________________________________________, intentionally and voluntarily make known my wishes in the event that I
am incapable of making an informed decision, as follows:
I understand that my advance directive may include the selection of an agent in addition to setting forth my choices regarding health care.
The term "health care" means the furnishing of services to any individual for the purpose of preventing, alleviating, curing or healing
human illness, injury or physical disability, including but not limited to medications; surgery; blood transfusions; chemotherapy; radiation
therapy; admission to a hospital, nursing home, assisted living facility or other health care facility; psychiatric or other mental health
treatment; and life-prolonging procedures and palliative care.
The phrase "incapable of making an informed decision" means: unable to understand the nature, extent and probable consequences
of a proposed health care decisi