Advance Directive for Health Care Form - Nebraska

Advance Directive for Health Care Form - Nebraska

A Nebraska Advance Directive is a revisable set of written instructions about future medical care that takes effect in cases when a patient becomes unable to make decisions for themselves. The purpose of the form is to let an individual plan their medical treatment in advance. The document is regulated by § 20-404 of Chapter 20 - Civil Rights. The document must be signed in front by two (2) individuals.

The form lists decisions on life-sustaining medical procedures and about the specific kinds of treatment the individual may or may not wish to receive and can be used to elect a spouse, relative, friend or attorney as a decision-maker in case the individual is unable to make their own decisions because of an illness, accident or incapacity.

The main difference between a Nebraska Advance Directive and a Nebraska Living Will is that a Living Will - also called a "directive to physicians" - is one form of the Advance Health Care Directive. It's more limited in nature and only state a patient's wishes for end-of-life medical care. You can download a ready-made version of the document below or make your own form with our form builder.

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What Is a Nebraska Advance Directive?

An Advance Directive is a legal document by which an individual appoints a proxy to make medical decisions for when they are no longer able to and to administer or withhold treatment and procedures based on their previously stated wishes. Advance Directives include two separate forms:

  • A Living Will (a written statement listing decisions about life-­sustaining procedures in the event of a terminal condition);
  • A Durable Power of Attorney for Health Care (a document appointing an attorney-in-fact to make medical decisions for the individual).

The attorney-in-fact should meet the following criteria:

  1. The health care proxy - or agent - must meet the state's legal requirements.
  2. The individual's doctor or a member of their medical care team may not be selected as a proxy.
  3. The elected individual should be trusted to be the patient's advocate in any disagreements about their care.

How to Write an Advance Directive in Nebraska?

You'll need to follow these important steps when preparing your document:

STEP 1 - Choose your health care agent - or proxy. This agent should be a person you trust to make medical decisions for you.

STEP 2 - Consider the kinds of treatment you do or do not want to receive in the event of a serious illness or incapacitation. Consider whether you want to:

  • Take antibiotics to treat infections;
  • Receive cardiopulmonary resuscitation (CPR);
  • Be on an extracorporeal membrane oxygenation (ECMO) machine when you cannot breathe on your own;
  • Be on a dialysis machine in case of kidney failure;
  • Be tube-fed if you can't eat or drink on your own.

STEP 3 - Keep the original completed and signed Advance Directive form with your medical records and give copies out to your health care proxy, physicians, health care providers, and - if necessary - to family members and close friends.

Download Advance Directive for Health Care Form - Nebraska

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