How to Fill Out and Sign the Virginia Advance Medical Directive

To fill out a Virginia advance medical directive, download the statutory form, complete the sections that apply to you, and sign it in front of two witnesses. The form itself follows the suggested layout in Virginia Code § 54.1-2984 and walks you through naming a healthcare agent, defining that agent’s powers, recording your treatment preferences, and addressing organ donation and the handling of your remains. No attorney is required. Most people finish in about half an hour.

Where to Get the Form

The Virginia State Bar publishes a free advance directive form as a downloadable PDF on its website at vsb.org. That version includes all five optional sections from the suggested statutory format along with plain-language guidance on what each power means. The Virginia Department of Health also links to a form through its Advance Health Care Directive Registry page.¹

You are not required to use those exact versions. Virginia law says a valid directive “may, but need not” follow the suggested form.² Sticking close to the statutory layout, though, makes it easier for a hospital to interpret the document quickly in an emergency.

Working Through the Five Sections

The suggested form contains five optional sections. Use any combination that fits your situation and cross through the ones you want to skip. Leaving a section out does not invalidate the rest.

Section I: Name Your Healthcare Agent

This section names the person who will make medical decisions for you when you cannot make them yourself. Fill in the agent’s full legal name, address, and phone number. You can also name one or more successor agents who step in if your primary agent is unavailable, unable, or unwilling to serve.

Pick someone you trust to follow your wishes under pressure, and tell that person you are naming them before you sign so the role does not come as a surprise.²

Section II: Define Your Agent’s Powers

This section spells out exactly what your agent can and cannot do. The statutory form lists specific powers, including consenting to or refusing any treatment, surgical procedure, or medication; authorizing admission to or discharge from a healthcare facility; and accessing your medical records.

Two provisions involving mental health admissions deserve careful thought before you initial them:

A power authorizing your agent to admit you to a mental health facility for up to 10 calendar days, provided you do not protest the admission and a physician confirms in writing that you have a mental illness, cannot make an informed decision, and need facility treatment.
A separate, more aggressive power letting your agent admit you even if you object, under the same physician-certification requirements. For this provision, your physician or a licensed clinical psychologist must attest at the time you sign the directive that you understand its consequences.

The choice is not all or nothing. Cross through any individual power you do not want your agent to have, and write in limitations if you want to narrow a power further.²

Section III: Record Your Treatment Instructions

This is the living will portion. You state your treatment preferences directly, and the instructions apply whether or not you have named an agent. The form asks you to address situations involving a terminal condition, a persistent vegetative state, or any condition with no reasonable expectation of recovery. For each scenario, indicate whether you want life-prolonging treatments continued, withheld, or withdrawn.

Specific treatments to consider as you fill this out:

Cardiopulmonary resuscitation (CPR)
Mechanical ventilation
Artificially administered nutrition and hydration, including tube feeding and IV fluids
Kidney dialysis
Antibiotics or other medications

You can also write in instructions about comfort care, including pain management, palliative sedation, or any other measures focused on keeping you comfortable rather than extending life. Use plain language and be specific. Vague phrases like “no heroic measures” leave too much room for interpretation and are the most common reason families end up in conflict with medical teams.³

Section IV: Name an Agent for Your Remains

This section names someone to authorize the disposition of your body. It is separate from the healthcare agent and can be a different person.

Section V: Record Your Organ and Tissue Donation Wishes

You can direct that an anatomical gift be made after your death and appoint an agent specifically for that purpose. The form gives you space to specify whether you want to donate your entire body, certain organs, tissues, or eyes, and to note any particular directions, such as donating only for transplantation rather than research.

If you have already registered as a donor through the Virginia DMV or Donate Life Virginia, this section reinforces that choice in a legally binding document. Once you express your intent to be an organ donor in a written document, Virginia law prevents anyone in the decision-making hierarchy from overriding that wish.⁴

Signing the Document and Finding Witnesses

A written advance directive must be signed by you in the presence of two subscribing witnesses.³ Both witnesses must be present at the same time you sign and must watch you do so.

The statute does not list specific disqualifications for witnesses. As a practical matter, avoid using your named healthcare agent or anyone who would inherit from you, because healthcare facilities sometimes raise questions when a witness has an obvious interest in your medical decisions.

Notarization is optional under Virginia law, but worth considering for two reasons. First, if you later want to register the directive with the state and then revoke it, the revocation must be notarized before the Department of Health will remove the document from the registry.⁵ Second, notarization adds a layer of authentication that can head off challenges if a family member later disputes whether you signed voluntarily.

After You Sign

Virginia maintains a free Advance Health Care Directive Registry so that authorized healthcare providers can retrieve your directive electronically during an emergency. The registry runs through the ConnectVirginia platform, and you upload the signed document at connectvirginia.org/adr. Only you, your legal representative, or your designee may submit the document for filing.¹ Registration is free and is not required for the directive to be legally valid. For questions about the registry, call 1-800-548-9455 (1-800-LIV-WILL), Monday through Friday, 9 a.m. to 5 p.m. Eastern.

Registration alone is not enough. Give physical or digital copies to your primary care physician, your healthcare agent, any successor agents, and close family members. Virginia law makes it your responsibility to notify your attending physician that an advance directive exists. Once notified, the physician must promptly place the directive or a copy of it in your medical records.⁶ If you are admitted to a hospital or long-term care facility, bring a copy with you or confirm that the facility can access the registry.

Changing or Revoking Your Directive Later

You can revoke the directive at any time, as long as you understand what you are doing. Virginia law recognizes three methods:⁵

A signed, dated written statement revoking the directive.
Physical destruction of the document, either by you or by someone acting in your presence at your direction.
An oral statement to your attending physician that you revoke the directive.

A revocation takes effect when communicated to your attending physician. If you revoke orally, make sure the physician documents it immediately.

Partial revocation also works. You can cross out or revoke specific provisions and leave the rest intact. Any remaining, nonconflicting provisions stay in effect.

One automatic trigger is worth knowing. If you or your spouse files for divorce, annulment, or a custody or visitation petition involving a child born to both of you, your agent’s authority is automatically revoked. You would need to execute a new directive naming a different agent.⁵

If you registered the original directive with the state registry, the revocation must be notarized before the Department of Health will remove it. Failing to notify the registry does not invalidate the revocation itself. It just means an outdated version may still be accessible electronically, which could create confusion in an emergency.

What Happens Without a Directive

If you never complete a directive, or if your directive does not name an agent, Virginia law establishes a default hierarchy of people who can authorize medical decisions for you if you become incapacitated. The attending physician turns to the following individuals in order of priority:⁴ a court-appointed guardian; your spouse, unless a divorce has been filed and is not yet final; an adult child; a parent; an adult sibling; other relatives in descending order of blood relationship; and finally, any other adult who has shown special care and concern for you and is familiar with your values, though that last person may not authorize withholding or withdrawing life-prolonging treatment.

When multiple people share the same priority level and disagree, the physician may rely on a majority of the reasonably available members of that class. Filling out a directive is how you take the decision out of that hierarchy and put it in the hands of the person you chose.

1
Virginia Department of Health. Advance Health Care Directive Registry
2
Virginia Code Commission. Virginia Code 54.1-2984 – Suggested Form of Written Advance Directives
3
Virginia Code Commission. Virginia Code 54.1-2983 – Procedure for Making Advance Directive; Notice to Physician
4
Virginia Code Commission. Virginia Code 54.1-2986 – Procedure in Absence of an Advance Directive
5
Virginia Code Commission. Virginia Code 54.1-2985 – Revocation of an Advance Directive
6
Virginia Code Commission. Virginia Code Title 54.1 Chapter 29 Article 8 – Health Care Decisions Act