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Colorado Advance Directive Form

A Colorado advance directive is a form that allows a resident of Colorado to designate a trusted person or organization to handle their medical and end-of-life decisions. The form instructs the designated agent to base these decisions on what they, in consultation with healthcare providers, determine to be in the person’s best interest. The directive outlines how the person will be treated, including whether or not to refuse breathing and feeding assistance.

Signing Requirements (§ 15-18-106(1), 15-18-105(1)) – Two (2) witnesses or a notary public.
The witnesses cannot be:

(a) The attending physician or any other physician;
(b) An employee of the attending physician or health-care facility in which the declarant is a patient;
(c) A person who has a claim against any portion of the estate of the declarant at his or her death at the time the declaration is signed; or
(d) A person who knows or believes that he or she is entitled to any portion of the estate of the declarant upon the declarant’s death either as a beneficiary of a will in existence at the time the declaration is signed or as an heir at law.

Sample

Download: Adobe PDF

MEDICAL DURABLE POWER OF ATTORNEY FOR HEALTHCARE DECISIONS

NAME OF
DECLARANT: [NAME]

DOB: [DAY] day of [MONTH], [YEAR]

ADDRESS:

PHONE#:

1. Appointment of Agent and Alternates
I, the Declarant, hereby appoint:

[NAME]
Name of Agent- Relationship
[PHONE NUMBER]
Agent’s Best Contact Telephone Number
[ADDRESS, CITY, STATE, ZIP CODE]
Agent’s Home Address

as my Agent to make and communicate my healthcare decisions when I cannot. This gives my Agent the power to consent to, refuse, or stop any healthcare, treatment, service or diagnostic procedure. My Agent also has the authority to talk with healthcare personnel, get information, and sign forms as necessary to carry out those decisions. If the person named above is not available or is unable to continue as my Agent, then I appoint the following person(s) to serve in the order listed below.

[NAME]
Name of Alternate Agent #1- Relationship
[PHONE NUMBER]
Agent’s Best Contact Telephone Number
[ADDRESS, CITY, STATE, ZIP CODE]
Agent’s Home Address

2. Instructions to Agent
My Agent shall make healthcare decisions as I direct below, or as I make known to him or her in some other way. If I have not expressed a choice about the decision or healthcare in question, my Agent shall base his or her decisions on what he or she, in consultation with my healthcare providers, determines to be in my best interest. I also request that my Agent, to the extent possible, consult me on the decisions and make every effort to enable my understanding and find out my preferences.
Optional: State here any desires concerning life-sustaining procedures, treatment, general care and services, including any special provisions or limitations:

[INSTRUCTIONS]

My signature below indicates that I understand the purpose and effect of this document. I do hereby revoke and cancel any and all prior Medical Powers of Attorney that I may have previously done and executed:
_______________________________________________
Signature of Declarant

[DAY] day of [MONTH], 20[XX]
Date