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Advance Healthcare Planning
Advance Directive Vermont

Advance Directive Vermont


Jennifer Mcgee


Updated on  

November 22, 2022

9 Mins


When a person chooses to make a Living Will, along with the Medical Power of Attorney, these two legal documents become an Advance Directive. 

An Advance Directive may include your sign, names of witnesses, their signatures, etc. in adherence to your state’s requirements. Every state has different requirements to be followed. Some states ask for witnesses and notaries, others look for different criteria to be followed. 

Likewise, some states consider Living Will and Advance Directive as different and separate documents, whereas others consider both documents the same. In some states, Living Will and Advance Directive are used interchangeably. 

In this article, you will get a complete guide for making an Advance Directive for Healthcare in Vermont.  

Legal Requirements for a valid Advance Directive

  • Written by the grantor (maker of Advance Directive): Yes
  • Grantor must be:
  • Above the age of 18 years: Yes/emancipated minor
  • Sound mind and memory: Yes
  • Signed by the grantor: Yes/by any adult on the grantor’s behalf
  • Signed by Proxy/Agent: Yes
  • Proxy/agent accepts his role in writing: Yes
  • Witness required: Yes
  • Number of witnesses: 2
  • Signed by the witnesses: Yes
  • Number of documents required: 1 
  • Other names for a Living Will in Vermont: Instructions for Healthcare
  • Other names for a Healthcare Power of attorney in Vermont: Power of attorney for healthcare
  • Proxy can decide on mental health issues: No

Who can be your witnesses in the Vermont Advance Directive?

Anyone can be your witness in Vermont if;

  • He is an adult i.e., above 18 years of age, and
  • He is a sound-minded person which means that he can understand the consequences of making an Advance Directive and the laws applied to it.

Note: Your witnesses cannot be: 

  • Your healthcare proxy/agent,
  • your supervising health care provider/ his employer,
  • Related to you by blood, adoption, or marriage (at least one witness),
  • Entitled to a share in the estate on your death (at least one witness),
  • the operator or an employee of a community care facility, 
  • the operator or an employee of a residential care facility for the elderly.

Note: Vermont state laws require the witnesses to sign the form and give in writing their declaration or you can give an acknowledgment before the public notary. 

Advance Directive Vermont

Who can be your Proxy in the Vermont Advance Directive?

Anyone can be your Proxy/Agent in Vermont if;

  • He is an adult i.e., above 18 years of age, and
  • He is a sound-minded person which means that he can understand the consequences of making an Advance Directive and the laws applied to it.

Who cannot be your Proxy/Agent:

  • your supervising health care provider, 
  •  if you are receiving care at a community care facility/residential care facility then its operator or its employee.
  •  if you are receiving care  at a health care institution then its employee.


  • the employee is related to you by blood, marriage, or adoption, 
  • the employee is your registered domestic partner, or 
  • the employee is your coworker at the facility or institution.

Other than the above legal requirements, the Proxy/Agent should be:

  • Trustable to adhere to your wishes and intentions.
  • Trustable to defend you if there’s any disagreement about your medical care.
  • He wanted to be your Attorney in Fact of his own free will to take care of your health affairs.
  •  He should not be your doctor or one of the caretakers.

Note: You can appoint an Alternate Proxy as well. The alternative Proxy/Agent will step in if the first person you name as a proxy is unable, unwilling, or unavailable to act for you or if you decide to revoke his authority.

Notarization required for Vermont Advance Directive?

You can either get an Advance Directive executed by signing the form in presence of the witnesses or get your signature notarized by signing an acknowledgment in front of the public notary.

The state of Vermont maintains an Advance Directive Registry where you can fill your Advance Directive. Your healthcare providers and loved ones will easily find a copy of your directive if you file your advance directive with the registry.

Learn about the requirements of Vermont Last Will and Testament and Vermont Last Will and Testament Template.

When does an Advance Directive come into effect in Vermont?

In Vermont, an Advance Directive doesn’t come into effect on signing the form by the grantor, proxy, and witnesses. An Advance directive comes into effect only when the doctor declares that you are incapable of deciding on your behalf and have become debilitated due to illness or injury.

Note: Your Vermont Advance Directive will not be effective in any medical crisis or emergency unless you become incapacitated to understand and communicate your wishes and consent.

How can an Advance Directive be revoked?

You can revoke or terminate your Vermont Advance Directive anytime by:

  • A written revocation,
  • An oral revocation, and
  • Tearing, burning, and obliterating or destroying the document in any other way.
  • Executing a new Advance Directive.

Note: An oral revocation of the Advance Directive or appointment of the Proxy/Agent will be effective once you give a written and signed revocation to your doctor.

Also, make sure to file any modification/revocation of your Vermont Advance Directive at the Vermont registry. 

How to amend or change an Advance Directive? 

You can make changes or amend your Advance Directive at any time in Vermont but once you have signed and witnessed/notarized it you have to resubmit a new document with the required changes. It is recommended to go through, double-check, and make sure of everything before signing the Advance Directive.

Vermont rules for divorce after making your Advance Directive 

Divorce from the spouse will not make any effect on the validity of the Vermont Advance Directive unless the spouse was named under Section 1 as the Proxy/Agent then you have to make changes and fill a new document of Advance Directive. The divorce or annulment of marriage will revoke the Vermont Advance Directive with immediate effect.

Sections of the Vermont Advance Directive Form

Section 1: Power of attorney for health care

You can fill this form out and provide all the details. This section allows you to appoint the Healthcare Attorney-in-fact/Agent and fill in his information along with the instructions for him to follow.

Vermont Advance Directive Sample Form


(1) DESIGNATION OF AGENT: I designate the following individual as my agent to make health care decisions for me: 

(Name of individual you choose as agent) (address) (city) (state) (zip code)

(home phone) (work phone) 

OPTIONAL: If I revoke my agent’s authority or if my agent is not willing, able, or reasonably available to make a health care decision for me, I designate as my first alternate agent: 

(Name of individual you choose as first alternate agent)


Section 2: Individual’s Instructions (Living Will)

This section states your wishes regarding medical care when your doctor determines that either:

  • that you are terminally ill and to prolong artificially your life you would need artificial life-sustaining procedures or your death will occur with or without the use of life-sustaining procedures, or 
  • that you are in a persistent vegetative state.

Vermont Advance Directive Sample Form


END-OF-LIFE DECISIONS: I direct that my health care providers and others involved in my care provide, withhold, or withdraw treatment in accordance with the choice I have marked below: (Initial only one box) 

[ ] (a) Choice NOT To Prolong Life I do not want my life to be prolonged if 

(1) I have an incurable and irreversible condition that will result in my death within a relatively short time, (2) I become unconscious and, to a reasonable degree of medical certainty, I will not regain consciousness, or 

(3) the likely risks and burdens of treatment would outweigh the expected benefits, OR 

[ ] (b) Choice To Prolong Life 

I want my life to be prolonged as long as possible within the limits of generally accepted health care standards


Section 3: Donations of Organs at death

Vermont Advance Directive Sample Form



Upon my death (initial applicable box): 

[ ] (a) I do not give any of my organs, tissues, or parts and do not want my agent, conservator, or family to make a donation on my behalf, 

[ ] (b) I give any needed organs, tissues, or parts, OR 

[ ] (c) I give the following organs, tissues, or parts only 

My donation is for the following purposes: (strike any of the following you do not want) 

(1) Transplant 

(2) Therapy 

(3) Research 

(4) Education


Section 4: Primary Physician

Vermont Advance Directive Sample Form



I designate the following physician as my primary physician: 

(name of physician) 

(address) (city) (state) 

(zip code) (phone) 

OPTIONAL: If the physician I have designated above is not willing, able, or reasonably available to act as my primary physician, I designate the following physician as my primary physician..


Section 5: Execution

You must sign in the presence of two witnesses. The details of the witnesses along with their signs are also required.

Vermont Advance Directive Sample Form


OPTION 1: Sign before a Witness _______________________ ___________________________________ (date) (sign your name) __________________________________________________________ (print your name) __________________________________________________________ (address) __________________________________________________________ (city) (state) (zip code)


State of California County of ___________________) On __________________________ before me,________________________________ (insert name and title of the officer) personally appeared _____________________________________________________, who proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies)......


I certify under PENALTY OF PERJURY under the laws of the state of California that the foregoing paragraph is true and correct. 

WITNESS my hand and official seal. 

Signature ______________________________________________

Section 6: Statement of Patient Advocate/Ombudsman

Vermont Advance Directive Sample Form


I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsman as designated by the State Department of Aging and that I am serving as a witness as required by section 4675 of the Probate Code. __________________________ ________________________________ (date) (signature) __________________________________________________________ (printed name) ___________________________________


Give photocopies of the signed original to your agent and alternate agent, doctor(s), family, close friends, clergy, and anyone else who might become involved in your health care. If you enter a nursing home or hospital, have photocopies of your document placed in your medical records. 

Be sure to talk to your agent(s), doctor(s), clergy, family, and friends about your wishes concerning medical treatment. Discuss your wishes with them often, particularly if your medical condition changes.

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Frequently Asked Questions

What is an Advance Healthcare Directive Vermont?

An Advance Directive is a legal-written document about your future medical care. It is a gift to family members and friends so that they won't have to guess what you want if you no longer can speak for yourself.

Does an attorney have to draft an advance directive in Vermont?

The procedure of creating advance directives is simple, you do not require an attorney though you may choose to consult one. However, an advance directive either it is written or oral needs to be witnessed by two individuals.

Who makes medical decisions if you are incapacitated in Vermont?

Under Vermont law, incapacity means when a physician declares that the individual can longer give informed consent. Any person may designate someone to make health care decisions on their behalf should they become incapacitated in Vermont.

What are the 2 major challenges with advance directives?

Advance directives have limitations. For example, an older adult may not fully understand treatment options or recognize the consequences of certain choices in the future. Sometimes, people change their minds after expressing advance directives and forget to inform others.

How do I get a medical power of attorney in Vermont?

It is the same as creating a document of Advance Directive. Firstly, choose Your Surrogate/Acting Agent, be specific on what decisions your Power of Attorney can make for you, and fill out your Vermont Medical Power of Attorney Form. Lastly, sign your document before subscribing to witnesses and a Notary Public.
Jennifer Mcgee
Parent to five young children. Expert in Estate Planning, Probate, and Family Law Matters. Volunteer with Victim’s Advocates in the local sheriff's department...
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Got Questions?

Hi, I’m Jennifer McGee.

Co-founder & Head of Legal at TrulyWill

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