Health Care Directive for COVID-19

I, ____________________________________________, having the capacity to make health care decisions, willfully and voluntarily make known my desire that in the event I am unable to communicate my instructions for my care, my treatment shall conform to these instructions.

TO ALL EMERGENCY RESPONDERS AND HEALTH CARE PROVIDERS: IF I AM DIAGNOSED WITH COVID-19, I AUTHORIZE ONLY LIMITED TREATMENT, AS DESCRIBED HERE.
1.	Treatment of COVID-19 Infection. If I am diagnosed with a COVID-19 infection and am unable to or am not competent to communicate my instructions for my medical care, I direct that my treatment for the infection and for conditions that result from the infection must follow the following preferences, and that I be permitted to die naturally if treatment under these restrictions is not sufficient:
a.	I direct that my respiratory care be limited to non-invasive treatments (such as oxygen through a face mask or nasal mask), and that I must not receive more invasive treatments such as intubation and use of a ventilator;
b.	I direct that I must not be treated with any antiviral treatment involving Veklury (remdesivir); however, my doctor may administer other therapies including but not limited to ivermectin and hydroxychloroquine, at his/her discretion; and
c.	I direct that I must not be vaccinated for COVID-19. 
d.	I direct that I must not be hospitalized;  ________ (initial)
i.	I direct that I receive only in-home health care, and that it be only under the supervision of my primary Health Care Provider:
ii.	Name: ______________________________
iii.	Telephone: __________________________
iv.	Email: ______________________________
I understand that these choices may result in my death earlier than others may think is necessary, including physicians. I insist that my instructions are followed, and I release any person from liability for ensuring they are followed, as described below. ________ (initial)
2.	Release and Indemnification. I understand the full import of this directive. I am emotionally and mentally capable to make the health care decisions contained in this directive. This directive is my expression of my legal right to refuse medical treatment. I accept the consequences of such refusal. If another person is appointed to make these decisions for me, I instruct that the person be guided by this directive. I hereby release and indemnify my Health Care Agent, my family, all medical personnel and health care providers, and any medical facility caring for me from any liability for actions taken in good faith in carrying out this directive. I instruct my Agent under Power of Attorney and/or my Personal Representative to defend and indemnify any such people who take actions in good faith to carry out the instructions in this directive. I further authorize my Agent and/or Personal Representative to take action against persons who act contrary to this directive, up to and including filing suit against them, if my Agent/Personal Representative believes such action is appropriate.
3.	Governing Law. I intend for this directive to qualify as a directive as described in RCW 70.122.030 and Chapter 71.32 RCW and as an expression of my instructions to my legal representatives, including my Agent under Power of Attorney and Personal Representative.
4.	Limitation. This directive will take effect only in the event that I am diagnosed with COVID-19 and am unable to communicate my preferences for treatment and care. This document supplements any other Health Care Directive I may have executed or shall execute. If there is conflict between the documents, this document shall control.
5.	Invalidity. It is my wish that every part of this directive be fully implemented. If for any reason any part is held invalid it is my wish that the remainder of my directive be implemented.
6.	Copies Valid as Original. A copy of this directive will be deemed equivalent to an original for all legal purposes.

Today’s Date
	Address	
Print Name
	City, State	
Signed
	Post Code	
Date of Birth
	Country	

STATE OF WASHINGTON	)
	) ss.
County of Thurston	)

On this day personally appeared before me ____________________________________________, to me known to be the individual described in and who executed the foregoing instrument, and acknowledged that he/she signed the same as his/her free and voluntary act and deed, for the uses and purposes therein mentioned.

Given under my hand and official seal this     day of 	, 2023.

_______________________________________________

Print/Type Name: ________________________________
NOTARY PUBLIC in and for the State of Washington, residing at ______________________________________
My appointment expires: __________________________