Free Rhode Island Living Will Form

A Rhode Island living will is a written document that outlines an individual’s preferences for medical care, particularly end-of-life care such as life support and resuscitation efforts. Also known as an “advance directive,” it is used when a person is terminally ill, permanently unconscious, or otherwise unable to make decisions about their medical treatment.

Last Updated: September 2026. This guide is reviewed and updated regularly to reflect current Rhode Island law. If you notice an error or outdated information, please contact us.

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A living will form includes decisions about using life-sustaining treatments, such as mechanical ventilation, artificial nutrition and hydration, and other medical interventions. The document is executed with a durable power of attorney for health care, which appoints another person (a healthcare proxy) to make medical decisions on the declarant’s behalf.

Healthcare providers in Rhode Island are legally bound to follow the instructions in a living will as long as it complies with state laws. If there is a conflict between the patient’s appointed health care proxy and the living will, the instructions in the living will generally take precedence unless the power of attorney document specifies otherwise.

Signing Requirements and Laws

Under R.I. Gen. Laws § 23-4.11-3, any competent individual eighteen years of age or older may sign a Rhode Island living will. Another person may sign at the declarant’s direction if the declarant cannot sign in person. The signing must happen in the presence of two subscribing witnesses who are not related to the declarant by blood or marriage.[1]

Each witness confirms in writing what they saw. Rhode Island’s statute gives the exact wording:

“The declarant is personally known to me and voluntarily signed this document in my presence.”

R.I. Gen. Laws § 23-4.11-3

Once the declaration is signed and witnessed, give copies to your physician and your health care agent, and keep the original where they can find it.

Rhode Island’s statute also sets out its own model declaration wording in § 23-4.11-3(d), the language many printed Rhode Island forms follow. That model wording includes a checkbox for artificial feeding: the declarant marks whether the authorization includes or does not include withholding or withdrawing artificial nutrition and hydration.[2]

Rhode Island Living Will Form Details

Document Name Rhode Island Living Will Form
State Form Name Rhode Island Advance Directive
Signing Requirements Two Witnesses
Validity Requirements § 23-4.11-3
State Laws: Rhode Island General Laws, Title 23, Chapter 4.11

What Makes a Living Will Valid in Rhode Island?

A Rhode Island living will is valid when a competent adult who is eighteen or older signs it, or directs someone else to sign it for them. The signing must happen in the presence of two witnesses who are not related to the declarant by blood or marriage. Each witness also signs, confirming they watched the declarant sign voluntarily.[1]


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Steps to Fill Out the Form

Below is a detailed guide to help you complete the Rhode Island living will form. Review the document periodically and update it if your health circumstances or preferences change. If you make changes, follow the same signing and witnessing steps for the new copy.

  1. 1. Enter the Declaration Date and Your Information. Fill in the day, month, and year of the declaration, then your full name and current address at the top of the Living Will/Advance Health Care Directive. (Page 2 of the form.)
  2. 2. Initial Your Health Care and End-of-Life Care Choices. Initial each treatment you want withheld, such as CPR, artificial nutrition or hydration, ventilation, dialysis, transfusions, or organ transplants, and initial the end-of-life conditions under which you do not want your life artificially extended. (Page 2 of the form.)
  3. 3. Add Additional Instructions. Use the blank lines to write any extra health care wishes not covered by the initialed choices above. Leave this blank if you have none. (Page 3 of the form.)
  4. 4. Appoint Your Health Care Agent. Enter your own name as principal, then your agent’s name, address, and phone number in the medical power of attorney section. (Page 3 of the form.)
  5. 5. Name a Substitute Agent. If your first agent cannot serve, enter a substitute agent’s name, address, and phone number. (Page 4 of the form.)
  6. 6. Review the Powers You Grant Your Agent. Read the list describing the health care decisions your agent may make on your behalf. No entries are needed here. (Page 4 of the form.)
  7. 7. Review the Effective Date and Records Release Terms. Read when the medical power of attorney becomes effective, generally your incapacity, and the terms authorizing your agent to access your medical records. (Page 6 of the form.)
  8. 8. Review the Remaining Terms. Read the agent’s duty to follow your wishes, the conservator nomination, the one-original clause, revocation of prior powers of attorney, and severability. (Page 7 of the form.)
  9. 9. Sign and Date the Declaration. Sign and print your name, and fill in the date under “In Witness Whereof” in front of your two witnesses. (Page 8 of the form.)
  10. 10. Complete the Witness Acknowledgment. Have each of your two witnesses print their name and address, then sign and date the witness block. (Page 8 of the form.)
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Other Rhode Island Forms
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General information, not legal or tax advice.

Sources

Unless noted otherwise, the sources below are from the R.I. Gen. Laws.

  1. R.I. Gen. Laws § 23-4.11-3.
  2. R.I. Gen. Laws § 23-4.11-3(d).
Published: Jun 19, 2024
Mara Erlach
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.