Advance Directive Forms by State: Where to Get and Keep Them

You can get a free advance directive form for every state from the state-by-state collections at AARP and CaringInfo, and many states also post their own form on a health department or attorney general website. Use the form for the state where your parent lives, and sign it exactly the way that form's instructions say: witnesses, a notary, or whatever combination the state requires. There's usually nothing to file. The original stays somewhere easy to reach, and copies go to the health care agent, the doctors and the hospital.

Below are the details, including where each piece should physically end up, which the usual state-by-state link lists don't get into.

What an advance directive is (and what your parent's state calls it)

An advance directive is a legal document that gives instructions for medical care and only takes effect if a person can't communicate their own wishes. The National Institute on Aging names the two most common kinds:

• A living will, which says which treatments your parent would want or not want, and under what conditions.
• A durable power of attorney for health care, which names the person who makes medical decisions when your parent can't. NIA notes that this person may be called a proxy, representative, surrogate or agent.

This is where it gets confusing. States use different names for the same ideas. AARP's form page points out that some states combine the two documents into one form, and that a living will may also be called an instruction directive. Texas calls its living will a "Directive to Physicians and Family or Surrogates" and its proxy a "Medical Power of Attorney" (Texas HHS). New York uses a Health Care Proxy. Maryland's state form has three parts: choosing an agent, treatment preferences (the "living will" part), and signatures.

Mayo Clinic lists six titles for the decision-maker alone, depending on the state: health care agent, proxy, surrogate, representative, attorney-in-fact and patient advocate. If your dad says he "did a proxy," look at the actual paper to see which half he did.

One thing an advance directive is not: a financial power of attorney. Maryland's form answers this directly. Asked whether the documents deal with financial matters, it says no, and to talk with a lawyer about planning for money in case of incapacity.

Where to get your parent's state form for free

NIA says you can set up advance directives for little or no cost, and many states have free forms of their own. Start with the state.

The state itself

Search your parent's state name plus "advance directive form" and look for a .gov address. Depending on the state, the form lives with the health department, the attorney general or another agency:

• Texas: the Health and Human Services forms page has the Directive to Physicians, the Medical Power of Attorney and the Out-of-Hospital DNR Order.
• New York: the Department of Health offers a fillable Health Care Proxy in English and 12 other languages.
• Maryland: the Office of the Attorney General publishes the state form (the version linked above is the accessible text version of the May 2024 form).
• Vermont: the Department of Health offers a short form, a long form and versions in other languages.

NIA also suggests calling the state attorney general's office or the local Area Agency on Aging, which you can find through the Eldercare Locator at 800-677-1116.

National collections of state forms

• AARP lists free printable forms for every state, with instructions at each link.
• CaringInfo, a program of the National Alliance for Care at Home (NIA's page still credits its earlier home, the National Hospice and Palliative Care Organization), has a free state-specific PDF and instructions for every state, plus Puerto Rico and Washington, D.C. You can fill the PDFs in on screen, but the page says to print them so they can be witnessed or notarized if the state requires it.
• The American Bar Association publishes a multi-state health care power of attorney form, but it doesn't work everywhere. The booklet's own lists of excluded states don't quite match (one page names New Hampshire, Ohio, Texas and Wisconsin, another adds Indiana), and it says people living in a nursing home or other care facility in California, Connecticut, Delaware, Nevada, New York, Oregon or Vermont shouldn't use it because of special witness rules (ABA form, hosted by UCLA). With a booklet that dates from 2021, the safer choice is usually your parent's own state form.

Veterans and hospital systems

If your parent gets care through the VA, there's a federal form: VA Form 10-0137, a combined durable power of attorney for health care and living will. Your parent's hospital system may also have the state form on hand, and can scan the signed copy into the chart (more on that below).

Do you need a lawyer?

Not necessarily. NIA says a lawyer can help but isn't required, and New York's form says outright that you don't need one. A lawyer can still earn the fee when the family situation is complicated, say a blended family or a parent whose capacity someone might later question. NIA also points out that some form websites charge for what's available free, and says to check that any website form is legally recognized in your parent's state.

Signing rules: witnesses, notaries, and who can't sign

This is the step that trips families up. In CaringInfo's words, states vary in their requirements for witnesses, notarization and other specifics, so read the form's instructions before anyone picks up a pen. A few real examples show how much they differ.

Sources: New York DOH form, Maryland form, Vermont DOH, California Probate Code 4674, Texas HHS. These are examples to show the range, not a complete rulebook for any state, and rules change, so the instructions on your parent's current form win.

Notice the pattern. The agent almost never gets to witness. The obvious helpers (you, your sibling, the nurse who happens to be in the room) are often disqualified. Some states also add rules for people in care facilities. In California, if your parent signs while a patient in a skilled nursing facility, the directive isn't effective unless a patient advocate or ombudsman signs as a witness, as one of two witnesses or in addition to a notary.

Small form details matter too. Maryland's instructions ask people to write their initials next to the choices they want, and not to use checkmarks or X marks.

Using one state's form in another state

If your parent splits the year between two states, this comes up fast. The short answer is "probably, but not always."

Maryland's form says it depends on the other state's law, and that most state laws recognize advance directives made somewhere else. CaringInfo is more cautious: some states honor out-of-state directives, some honor them only if they're similar to their own law, and some states don't have an answer.

Both CaringInfo and NIA give the same practical advice. If your parent spends a lot of time in more than one state, complete the form for each state and keep a copy in each place. Harvard Health adds that after a move, it's best to check that the form meets the new state's requirements.

What matters is where your parent is when something happens. Picture, as a made-up example, a parent who winters in Florida but only ever signed an Ohio form. That's the setup to fix before the next trip south.

Does it have to be filed anywhere?

Generally, no. There's no court filing, and most states don't run any place to send them. Maryland's form even tells people not to return completed forms to the attorney general's office.

A handful of states run optional registries, which store a copy or note where the original is so hospitals can look it up:

• California: the Secretary of State keeps an Advance Health Care Directive Registry. Registration is entirely voluntary, carries a small fee, and is done by mail, not online.
• North Carolina: the Secretary of State runs a registry whose cards, since February 2022, carry a QR code that anyone holding the card, including the agent or health officials, can scan to pull up the document.
• Vermont: the Department of Health's registry is free, and the state contracts with the Vermont Ethics Network to support it.
• Idaho: directives that used to be registered with the Secretary of State were moved to a new registry at the Department of Health and Welfare. If your parent registered there years ago, they fill out a form to set up an account in the new system.

Registries also close or stall. Washington's health department started a registry in 2006, but a 2016 state legislative bill report says most of its funding was cut in the 2011-13 budget and it has not accepted new declarations since July 1, 2011. Lists of state registries you find online are often years old, so check the state's own site before relying on one.

Even where a registry exists, treat it as a backup. Registration is voluntary, so a hospital that finds nothing can't conclude there's no directive. And if your parent updates the document, NIA says to make sure the latest version is on record with the registry.

Where the original goes, and who gets copies

Mayo Clinic's advice is to keep the original in a safe place that's easy to reach, give copies to the doctor and the health care agent, and keep a record of who has one. "Easy to reach" rules out a bank safe deposit box for most families, since nobody can open it on a Saturday night. Our guide on where to keep important documents weighs home safes, deposit boxes and attorneys' files in more detail.

One reasonable way to sort the pieces, pulled together from NIA, Mayo Clinic, New York, Maryland and National POLST guidance:

Sources for the POLST row: National POLST. Wallet card: NIA and Mayo Clinic suggest carrying one that says your parent has an advance directive and where it's kept.

New York's health department also suggests carrying a copy in a wallet or purse, and Maryland's form says to bring one along to any hospital admission.

Getting it into the medical record

A copy sitting in a doctor's mail pile doesn't help in the ER. The goal is a scanned copy in your parent's chart, where clinicians across that health system can pull it up.

UCSF Health, for example, lists three ways to get the document into its records: hand a copy to someone on the care team to scan in, upload it through the Advance Care Planning page in its MyChart patient portal, or mail it to medical records. Many systems that use MyChart have a similar upload page; look under the menu for "advance care planning" or ask the front desk. A few practical notes:

• Scan every page, signatures and witness pages included, into one PDF.
• If your parent sees doctors in two unrelated health systems, each one needs its own copy. Their records don't always talk to each other.

If you plan to upload it yourself through portal proxy access, our guide to a HIPAA authorization for a parent explains how that access works and why it's separate from the health care power of attorney.

There's a nudge built into Medicare, too. NIA notes that Medicare covers advance care planning as part of the annual wellness visit, which makes that visit a natural time to hand the doctor a copy.

An advance directive is not a POLST

Paramedics generally can't act on an advance directive. National POLST says legal documents like advance directives, living wills and health care powers of attorney name a decision-maker and state general wishes, but "they are not orders that EMS providers can follow". A POLST is a medical order, signed by a clinician, for people who are seriously ill or frail.

Most adults only need an advance directive. If your parent is very sick or frail, ask their doctor whether a POLST makes sense too. Our POLST form guide covers what's on it, what each state calls it, and how it fits with the advance directive. For the paramedics' side of things, there's also our guide to an emergency information sheet for paramedics, which covers the one page a crew actually reads.

When to review it: the "five D's"

Harvard Health passes along a rule of thumb from the American Bar Association's Commission on Law and Aging: re-examine health care wishes whenever one of the five D's happens.

1. Decade: at the start of each new decade of life.
2. Death of a loved one. If that person was the named agent, the form needs a new name.
3. Divorce or another major family change. Harvard notes that in many states a divorce automatically revokes a former spouse's authority as agent.
4. Diagnosis of a serious medical problem.
5. Decline: a significant worsening of an existing condition, especially one that affects living independently.

NIA adds a lighter, yearly habit: review at least once a year and after major events like retirement or a move out of state.

Changing it usually means a fresh form, not edits in the margin. Mayo Clinic says to fill out a new form, hand out new copies and get rid of the old ones; Harvard suggests asking for the old copies back. NIA adds a useful twist for your own files: keep the previous version with the date it was replaced written on it, so there's never a question of which one is current. Maryland's form notes that once made, a directive doesn't expire on its own; it stays in effect until your parent revokes it.

Mistakes that undo a perfectly good form

• The wrong witness. The agent signs as a witness, or both witnesses are relatives in a state that needs one unrelated person. The form looks finished and may not be valid.
• Skipping the notary in a state that requires one. The form's instructions say; read them before signing day.
• One state's form, two states of living, with nothing on file in the second state.
• The only original in a safe deposit box. Or in a lawyer's vault across the country.
• Old copies still out there. For example (a made-up one), a hospital still holding a 2009 version that names an aunt who has since died.
• Assuming paramedics will follow it. Without a POLST or out-of-hospital DNR, crews generally start full treatment.
• Nobody knows it exists. NIA calls the conversation the most important part of advance care planning. A form your parent signed in secret is a form nobody brings to the hospital.

If your parent never signed one and can no longer make decisions, the options are different; see what to do when a parent has no power of attorney.

Frequently asked questions

Can I download an advance directive form for free?

Yes. Many states publish one free, usually through the health department or attorney general, and AARP and CaringInfo link to a free form for every state. NIA notes that paid sites exist but aren't necessary.

Does an advance directive have to be notarized?

It depends on the state. New York and Maryland need two witnesses and no notary. California accepts two qualified witnesses or a notary, and Texas allows a notary in place of witnesses if its requirements are met. Other states have their own rules, so follow the instructions on your parent's state form exactly.

Is an advance directive from one state valid in another?

Often, but not always. Maryland's form says most states recognize directives made elsewhere, while CaringInfo notes that some states only honor forms similar to their own and some have no clear rule. If your parent lives part of the year in another state, complete that state's form too.

Do you have to register or file an advance directive?

No. Registration is optional in the states that offer it, such as California, North Carolina, Vermont and Idaho. The signed form is valid without it. Copies to the agent, the doctors and the hospital matter more.

Who should keep the original advance directive?

Usually your parent, at home, somewhere family can reach quickly. Copies go to the health care agent, the doctors and the hospital, and a wallet card can say where the original is.

Finding the folder later

The forms are free and fairly quick to fill in. What falls apart is the record around them: which version is current, which doctor's office got a copy, whether the wallet card still names the right agent. If you're gathering the rest of your parent's papers too, our list of important documents for aging parents is a good map, and questions to ask aging parents helps with the conversation part.

A pen, a folder and the two tables above are honestly enough to track it yourself. If you'd rather hand off the organizing, Emergency Binder Now runs a guided interview (plan on around 25 minutes) and builds a printable binder for your parent from your answers. Its legal documents page notes whether an advance directive, health care proxy and POLST exist, where each original sits, and who holds copies. To check the layout before deciding, see a sample binder.

Please read this as general information rather than legal or medical advice. Each state sets its own advance directive forms, witness and notary rules and registry options, and they change. Go by the instructions on your parent's current state form, and bring in an elder law attorney in that state if anything about their situation is complicated.