Create your Official Louisiana Medical Power of Attorney and Living Will

Enter Your information here.

We'll send your Official Louisiana Medical Power of Attorney to the email address you enter here.

First Name

Email Address

Last Name

Click Next to add the principle information.

Enter the Principle information here.

This is the person that is choosing someone to act on their behalf.

Principle First Name

Principle Last Name

Principle Social Security Number

Principle Street Address

Address Line 2

Principle City

Principle ZIP Code

Principle Parish

Click Next to add the agent information.

Enter the Agent information here.

This is the person that will be authorized to make medical decisions on the principle's behalf.

Agent First Name

Agent Last Name

Agent Social Security Number

Agent Street Address

Address Line 2

Agent City

Agent ZIP Code

Agent Parish

Choose one of the following options to complete your Official Louisiana Medical Directive.

That all life-sustaining procedures, including nutrition and hydration, be withheld or withdrawn so that food and water will not be administered evasively.

That all life-sustaining procedures, except nutrition and hydration, be withheld or withdrawn so that food and water will not be administered evasively.

Louisiana

Official Medical Power of Attorney