How to Fill Out Your North Carolina Advance Directive Form

A North Carolina advance directive form is actually two separate statutory documents: a Health Care Power of Attorney, which names someone to make medical decisions for you, and a Living Will, which tells doctors directly which life-prolonging treatments you do or do not want. You can complete one or both. Each must be signed in front of two qualified witnesses and a notary public, and neither takes effect unless a physician determines you can no longer make or communicate your own health care decisions.

The Two Documents and What Each Does

The Health Care Power of Attorney gives decision-making authority to a person you name — your health care agent. Under the statutory form in N.C. Gen. Stat. § 32A-25.1, that authority is broad: consenting to or refusing surgery, medications, and diagnostic procedures; admitting or discharging you from a hospital, nursing home, or hospice; authorizing or withholding life-prolonging measures; consenting to mental health treatment including psychotropic medications and electroconvulsive therapy; accessing your protected health information under HIPAA; and directing the disposition of your remains.¹

The Living Will — formally titled an Advance Directive for a Natural Death — speaks for you directly instead of through an agent. It tells your medical team which life-prolonging measures you want withheld or withdrawn in specific end-of-life situations. The statutory Living Will form appears in N.C. Gen. Stat. § 90-321.²

Most people complete both. The Power of Attorney covers the full range of health care decisions a human agent might need to handle; the Living Will provides written proof of your own wishes about end-of-life care, which the agent and doctors must follow.

Where to Get the Forms

Both statutory forms are published by the North Carolina General Assembly and can be downloaded from the Secretary of State’s advance directive portal at sosnc.gov.³ Use of the statutory form is optional. Other formats that satisfy the requirements of Chapter 32A (for the Power of Attorney) or Article 23 of Chapter 90 (for the Living Will) are also valid, but the statutory forms are the safest choice because hospitals and courts already know how to read them.⁴

Filling Out the Health Care Power of Attorney

Name Your Agent and Alternates

Section 1 of the form asks for the full legal name, address, and phone number of your primary health care agent. Choose someone who knows your values, can hold their own in a tense conversation with doctors, and is likely to be reachable in a crisis. Naming your own attending physician or an employee of a facility where you live creates an obvious conflict of interest.

The form also lets you name one or more alternates in order of preference, with the same contact details. If your primary agent is unavailable, unwilling, or unable to act, the first alternate takes over automatically. Skipping this section is risky: if your primary agent can’t be reached, no one has legal authority to act under the directive, which can push your family into a guardianship proceeding.

Name the Physicians Who Decide You Lack Capacity

Section 2 provides space for one or two physicians who will determine whether you have lost the ability to make or communicate health care decisions. That determination is the trigger that activates your agent’s authority. Listing a long-standing primary care doctor or specialist means someone who already knows your medical history makes the call. If you leave the lines blank or the named physicians are unavailable, your attending physician at the time makes the determination.¹

Set the Scope and Any Limits

Section 4 grants your agent the full default authority described above. Section 5 is where you narrow it. If there are treatments you never want, or treatments you always want regardless of prognosis, write them in. Be specific. “I do not want my agent to authorize withdrawal of a ventilator” is clear. “I want everything possible done” is not, because it leaves your agent guessing when the choices get granular.

A subsection addresses mental health treatment specifically, letting you authorize your agent to consent to psychotropic medications, electroconvulsive therapy, and short-term admission to a mental health facility. North Carolina also offers a separate Advance Instruction for Mental Health Treatment under Chapter 122C if you want to address those issues in greater detail.⁵

Filling Out the Living Will

The Living Will form applies in three situations, which you select by initialing the appropriate lines:²

You have a terminal and incurable condition.
You are in a persistent vegetative state.
You have advanced dementia or another condition causing severe and permanent deterioration with no realistic hope of meaningful recovery.

For each situation you select, you indicate whether you want life-prolonging measures withheld or withdrawn. The form then asks two specific follow-up questions: whether you want artificial nutrition and hydration (food and water through tubes if you can no longer eat or drink on your own), and whether you want mechanical ventilation (a machine breathing for you). You initial yes or no next to each.

The form also leaves space to write in additional preferences — for example, palliative sedation but not CPR. Keep anything you add short and unambiguous. A nurse reading this at 2 a.m. needs to understand your wishes without interpretation.

Signing, Witnesses, and Notarization

Neither document carries legal weight until it is properly signed, witnessed, and notarized. The requirements are nearly identical for both.

You sign the document, or direct someone else to sign on your behalf, in the simultaneous presence of two qualified witnesses. North Carolina law disqualifies certain people from serving as witnesses. A witness cannot be:⁶

Related to you by blood or marriage.
Entitled to any part of your estate under your will or under North Carolina’s intestacy laws.
Anyone with a financial claim against your estate.
Your attending physician or mental health treatment provider.
A paid employee of your attending physician, your health care facility, your nursing home, or an adult care home where you reside.

The Living Will carries the same witness restrictions.⁷ Friends, neighbors, and coworkers who don’t fall into any of those categories work well.

After the witnesses sign, a notary public acknowledges the document. For the Living Will, a clerk or assistant clerk of superior court can perform the acknowledgment in place of a notary.⁷ Everyone — you, both witnesses, and the notary — must be physically present at the same time. North Carolina caps notary fees at $10 per signature for in-person notarization and $25 per signature for remote notarization.⁸ Banks, libraries, and UPS stores commonly offer notary services. If you’re completing both documents, budget for notarization of each.

After You Sign: Registration and Copies

North Carolina maintains an Advance Health Care Directive Registry through the Secretary of State’s office. Registration is optional. An unregistered directive is still legally valid, but filing it makes the document instantly accessible to any hospital in the state.⁹ Only the person who executed the document can submit it. The filing must include the notarized document, a return address, and a ten-dollar fee.¹⁰ Once processed, you receive a wallet-sized registry card listing a file number and password that hospital staff use to pull up your documents online.

Registration alone is not a distribution plan. Give physical copies to:

Your health care agent and any alternates, so they have the document in hand before a crisis.
Your primary care physician, with a request to scan it into your medical record.
Any hospital where you receive regular care, through its medical records department.
A secure spot at home where a trusted person can find it.

Changing or Revoking the Directive

You can revoke a Health Care Power of Attorney at any time while you are still capable of making and communicating health care decisions. North Carolina recognizes three methods: signing and acknowledging a written revocation, executing a new Health Care Power of Attorney (which automatically supersedes the old one), or communicating your intent to revoke by any means available to you, including verbally.¹¹

Revocation only takes effect once you communicate it to each named agent and to your attending physician. Until they know, the old directive is still the one hospitals will follow. Tearing up your copy at home is not enough.

One revocation happens automatically. If your agent is your spouse and a court enters a decree of divorce or separation, that agent’s authority is revoked by operation of law. A successor agent, if you named one, steps in. If you didn’t, you have no agent at all until you execute a new document.¹¹

If you registered the original directive, submit the revocation to the registry as well. Any revocation filed with the registry must be notarized.⁹ Even without a change, review your directive after major life events — a new diagnosis, a move, retirement, the death of a named agent — and at least once a year.

Two Things the Advance Directive Does Not Cover

A MOST form (Medical Orders for Scope of Treatment) is a separate document, recognized under N.C. Gen. Stat. § 90-21.17 and signed by a physician, physician assistant, or nurse practitioner. First responders treat it as an active clinical order, which an advance directive is not. If a MOST and your Living Will conflict, the MOST can suspend the conflicting portion. Many people complete both.

If you travel or live part of the year in another state, your Living Will remains valid in North Carolina if it was executed in accordance with the other jurisdiction’s requirements or North Carolina’s.¹² Whether another state honors your North Carolina directive depends on that state’s law. If you spend significant time in a second state, have a local attorney confirm your North Carolina documents meet that state’s execution requirements.

1
North Carolina General Assembly. North Carolina Code 32A-25.1 – Statutory Form Health Care Power of Attorney
2
North Carolina General Assembly. North Carolina Code 90-321 – Right to a Natural Death
3
North Carolina Department of Administration. Advance Care Planning Information
4
North Carolina General Assembly. North Carolina Code 32A-25.1 – Statutory Form Health Care Power of Attorney
5
North Carolina General Assembly. North Carolina Code 122C-73 – Scope, Use, and Authority of Advance Instruction for Mental Health Treatment
6
North Carolina General Assembly. North Carolina Code 32A-16.1 – Statutory Health Care Power of Attorney
7
North Carolina General Assembly. North Carolina Code 90-321 – Right to a Natural Death
8
North Carolina General Assembly. North Carolina Code 10B-31 – Fees for Notarial Acts
9
North Carolina General Assembly. North Carolina Code 130A-466 – Filing Requirements
10
North Carolina General Assembly. House Bill 1362
11
North Carolina General Assembly. North Carolina Code Chapter 32A – Powers of Attorney
12
North Carolina General Assembly. North Carolina Code Chapter 90 Article 23