http://www.learningplaceonline.com/stages/together/wishes/wishes-5.htm

We are pleased to reprint the text of "Five Wishes" directive for advanced
care with permission from Aging With Dignity. To use this as a legal
document in those states that accept it (see first article), you MUST send
for the paper version (only $5). However, even though you may live in a
state where Part A is not accepted as a legal document, it is a good tool
for thinking through Durable Power of Attorney for Health Care issues. And
in those states you can often get a legal form from most hospitals and
some doctor's offices.

Part B is perhaps one of the strongest features of Five Wishes because it
goes into comfort and remembrance issues. Reading this online edition can
encourage you to discuss these topics with your family.

The document was designed by the Commission on Aging with Dignity, which
is a private, non-profit organization founded in 1996 to affirm and
safeguard human dignity, and to promote better care of the dying. Living
in Mother Teresa's home for the dying in Washington, DC as a full-time
volunteer inspired Aging with Dignity's founder, Jim Towey, to develop
Five Wishes. If you would like more information on Aging with Dignity,
visit their website or you can write them at P. O. Box 1661, Tallahassee,
Florida 32302, 1-888-5-WISHES (or 1-888-594-7437).

Important Note One:

This material is NOT intended to be legal advice but to help you become
aware of a way you can make your wishes known concerning care at the end
of your life, information that will make certain your family members and
friends won't need to guess what you want.

Important Note Two:

This form is not legal unless you live in one of the states below and even
then it must be filled out on the printed version you can get from Aging
With Dignity.

Five Wishes makes it easier for you to let your doctor, family, and
friends know how you want to be treated if you become seriously ill and
cannot tell them. Five Wishes is a gift to your family members and friends
so that they won't have to guess what you want. Five Wishes is easy to
understand and simple to use.

Five Wishes has captured the hearts and minds of people in Florida from
the day it was introduced. Hundreds of thousands of Floridians are using
Five Wishes, including Florida's Governor, Supreme Court Chief Justice,
and thousands of others.

Because Five Wishes was so successful in Florida, it was featured on the
NBC Today Show. Aging with Dignity wanted to see if it could be used in
other states. We consulted experts who reviewed the laws in all fifty
states. We found out that Five Wishes could be written in a way that made
it valid under the health care statutes in most states.

With the help of the American Bar Association Commission on Legal Problems
of the Elderly, we came up with this new version of Five Wishes. They are
confident that Five Wishes meets the legal requirements under the health
decisions statues of 35 states and the District of Columbia.

Five Wishes States

If you live in the District of Columbia or one of the 35 states listed
below, you can use Five Wishes and have the peace of mind to know that it
meets your state's requirements under the law:

[notes from me - see the rest there
There's 5 pages to click through.
I'm including the disclaimers.
and apparently you can get (presumably the uptodate, for your state,
version) in hospitals or doctor's offices]

Five Notes of Particular Interest

1. Five Wishes is meant to be a helpful resource for you as you talk with
your doctor, family and others about how you want to be treated when you
are serious ill. Five Wishes does not try to answer all questions about
all situations you may come up against. And remember, while the
information in this booklet is up-to-date as of the date it was published,
laws can change quickly! So if you have a specific question or problem,
you should talk to a professional for medical or legal advice.

2. Aging With Dignity is happy to send you Five Wishes free of charge. If
you can, they ask that you please send them a check or money order in the
amount of four dollars. It will help them reduce their mailing and
handling costs.

3. On the form you must send for, there is a card you can fill out and
laminate for safekeeping in your wallet. It is an "Important Notice to
Medical Personnel: I have a Five Wishes Living Will.".

4. In addition to the printed version of Five Wishes, there is a Five
Wishes Video that can be used as a teaching guide. It discusses the
importance of advance care planning; gives instruction on completing Five
Wishes; tells what to do after you complete Five Wishes so that your
wishes are followed; and answers common questions, through a concise
25-minute presentation. The cost is only $19.95.

5. To obtain copies of Five Wishes and the Five Wishes Video, please print
and complete the order form [located on the order page of the Aging with
Dignity website] and mail or fax it to:

Aging with Dignity
PO Box 1661
Tallahassee, FL 32302-1661
Phone: (850) 681-2010
1-888-5-WISHES (or 1-888-594-7437)
Fax: (850) 681-2481
http://www.agingwithdignity.org

Orders with payment by credit card or purchase order are welcome by fax or
mail. Checks may be made payable to Aging with Dignity, and should be
mailed along with the order form./end quotes from webpage/

J-not an expert