New Jersey Advance Directive

Information you will need

• Representative Name
• Representative Address and Phone
• Alternate Representative Name
• Alternate Representative Street
• Alternate Representative City
• Alternate Representative State
• Alternate Representative Phone
• Recipient Name
• Recipient City
• Recipient State
• Recipient Phone
• Principal Name
• All Life Sustaining Procedures
• Specific Life Sustaining Procedures
• Terminal Condition
• Terminal Condition Definition
• Permanently Unconscious
• Incurable and Irreversible Condition
• Special Concerns
• Nurtition and Hydration
• CPR
• Additional Explanation
• Additional Instructions
• Additional Health Care Instructions

…and 29 more fields in the PDF.

The form includes 6 signature lines, a witness section.

The document text refers to the laws of New Jersey.