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Iowa state bar form 123 2006-2025

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The document is an official form from the Iowa State Bar Association that outlines a Declaration Relating to Life-Sustaining Procedures (Living Will) and a Durable Power of Attorney for Health Care Decisions (Medical Power of Attorney). It allows individuals to specify their wishes regarding life-sustaining treatments in case of terminal illness or permanent unconsciousness, and designates an agent to make health care decisions on their behalf when they are unable to do so. The form includes sections for additional provisions, witness signatures, and information about the authority granted under HIPAA.

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Click ‘Get Form’ to open it in the editor.
Begin with Section I, where you declare your wishes regarding life-sustaining procedures. Clearly state your desires if you have an incurable condition, ensuring that any specific instructions are noted in the 'Additional Provisions' section.
Move to Section II to designate your health care agent. Type or print the name, address, and phone number of your chosen agent. Ensure this person understands their responsibilities.
If applicable, provide an alternate agent's information in the optional section. This ensures continuity in decision-making if your primary agent is unavailable.
Complete the signature section by signing and dating the document. Remember, this must be done before a notary public or two witnesses as specified.

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Versions	Form popularity	Fillable & printable
2013	4.9 Satisfied (283 Votes)
2006	4 Satisfied (24 Votes)

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