Free Nebraska Living Will Form

The medical power of attorney section takes effect once your treating physician certifies, in writing, that you can no longer make your own health care decisions. If you choose the persistent vegetative state option in the living will section, a second physician must also confirm there is no reasonable chance of recovery.

What Makes a Nebraska Living Will Valid?

Your Nebraska living will is valid when you sign it, or direct someone else to sign for you, and two adult witnesses or a notary public then attest to the signing. This rule comes from Nebraska’s Rights of the Terminally Ill Act, part of the Nebraska Revised Statutes. You must sign voluntarily, in the presence of the witnesses or the notary.^[1.1]

If you are unable to sign the document yourself, another person may sign it for you. This is only valid if that person signs in your presence and at your direction.^[1.1]

Two adult witnesses can attest to your signature, or a notary public can do this instead.^[1.1] State law restricts who may serve as a witness:

• No more than one witness may be an administrator or employee of a health care provider who is caring for or treating you.^[1.1]
• No witness may be an employee of a life or health insurance provider for you.^[1.1]

These restrictions do not apply to a notary public.^[1.1] Notarization is optional, but it can add formality and help the document gain acceptance across different medical facilities and states.

You can revoke your living will at any time, in any way that communicates your decision clearly. Put the revocation in writing and tell your health care provider directly, so there is no confusion about your current wishes.

Nebraska Living Will Form Details

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How to Create a Living Will in Nebraska

To create your Nebraska living will and medical power of attorney, fill in your personal details, mark which treatments you want or refuse, name a health care agent, then sign the finished document in front of two witnesses. The steps below follow the form in order.

1. Fill In Your Personal Information. Enter your full name, address, and the date at the top of the declaration. You can type directly into the downloaded PDF with FormsPal’s PDF editor, or print it and fill it out by hand.
2. Choose the Treatments You Want Withheld. Initial next to each life-sustaining treatment you do not want, such as CPR, tube or IV nutrition and hydration, a ventilator, dialysis, blood transfusions, or organ transplants.
3. Select the Conditions That Trigger Your Wishes. Initial the end-of-life conditions under which these instructions apply, such as a terminal condition or a persistent vegetative state.
4. Add Additional Instructions (Optional). Write out any other care preferences, such as pain management or palliative care, that the form’s checklist does not cover.
5. Name Your Health Care Agent. Give the name, address, and phone number of the person who will make medical decisions for you under the medical power of attorney.
6. Name a Successor Agent (Optional). List a backup agent to serve if your first choice is unable or unwilling to act.
7. Review Your Agent’s Powers. The form lists the specific decisions your agent may make, from consenting to treatment to arranging your care.
8. Review the Additional Terms. This section covers your agent’s access to your medical records, the nomination of a conservator, and the revocation of any earlier health care power of attorney.
9. Sign and Date the Document. This document’s witness acknowledgment requires you to sign before two independent witnesses. It does not include a notary option, even though Nebraska law allows a notary as an alternative for a living will declaration.^[1.1]
10. Have Your Witnesses Sign. Each witness prints their name, gives their address, and signs and dates the Witness Acknowledgment. Neither witness can be your named agent or your health care provider.
11. Distribute Copies. Give copies to your agent, your primary care physician, and anyone else who should have one.

“You must sign this document before two independent witnesses to witness and acknowledge your signature.”

Other Nebraska Forms
Below are various other Nebraska templates completed by our users. Try our simple builder to customize these forms to your preferences.

Nebraska Last Will Nebraska Small Estate Affidavit Nebraska Bill of Sale Nebraska Power of Attorney Nebraska Non-compete Agreement Nebraska Prenuptial Agreement Nebraska LLC Operating Agreement

General information, not legal or tax advice.

Sources

1. Neb. Rev. Stat. § 20-404.
   • 1.1 § 20-404
   • 1.2 § 20-404(2)

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.