Modify HC POA/Adv Direct.

GENERAL ASSEMBLY OF NORTH CAROLINA
SESSION 2025
H 4
HOUSE BILL 349
Committee Substitute Favorable 3/25/25
Senate Health Care Committee Substitute Adopted 5/22/25
Senate Judiciary Committee Substitute Adopted 6/17/26

Short Title: Modify HC POA/Adv Direct. (Public)
Sponsors:
Referred to:
March 11, 2025
*H349-v-4*
A BILL TO BE ENTITLED 1
AN ACT UPDATING REQU IREMENTS FOR HEALTH CARE POWERS OF ATTOR NEY 2
AND ADVANCE HEALTH C ARE DIRECTIVES AND A UTHORIZING THE 3
SECRETARY OF STATE T O RECEIVE ELECTRONIC FILINGS OF ADVANCE 4
HEALTH CARE DIRECTIVES. 5
The General Assembly of North Carolina enacts: 6
7
PART I. HEALTH CARE POWERS OF ATTORNEY 8
SECTION 1.1. G.S. 32A-16(6) reads as rewritten: 9
"(6) Qualified witness. – Except as provided in G.S. 32A-16.1, a witness in whose 10
presence the principal has executed the health care power of attorney, who 11
believes the principal to be of sound mind, and who states that he or she (i) is 12
meets all of the following criteria: 13
a. The witness is not related within the third degree to the principal nor 14
to the principal's spouse, (ii) does spouse. 15
b. The witness does not know nor have a reasonable expectation that he 16
or she would be entitled to any portion of the estate of the principal 17
upon the principal's death under any existing will or codicil of the 18
principal or under the Intestate Succession Act as it then provides, (iii) 19
provides. 20
c. The witness does not have a claim against any portion of the estate of 21
the principal at the time of the principal's execution of the health care 22
power of attorney. 23
d. The witness is not the attending physician or mental health treatment 24
provider of the principal, nor a licensed health care provider who is a 25
paid employee of the attending physician or mental health treatment 26
provider, nor a paid employee of a health facility in which the principal 27
is a patient, nor a paid employee of a nursing home or any adult care 28
home in which the principal resides, and (iv) does not have a claim 29
against any portion of the estate of the principal a t the time of the 30
principal's execution of the health care power of attorney. resides, 31
unless the witness has both (i) received training on recognizing 32
whether the declarant meets the legal requirements for competency to 33
execute the health care power of attorney and (ii) has been designated 34
General Assembly Of North Carolina Session 2025
Page 2 House Bill 349-Fourth Edition
by his or her employer to serve as a witness to the execution of the 1
health care power of attorney." 2
SECTION 1.2. G.S. 32A-25.1(a) reads as rewritten: 3
"(a) The use of the following form in the creation of a health care power of attorney is 4
lawful and, when used, it shall meet the requirements of and be construed in accordance with the 5
provisions of this Article: 6
7
HEALTH CARE POWER OF ATTORNEY 8
9
NOTE: YOU SHOULD USE THIS DOCUMENT TO NAME A PERSON AS YOUR 10
HEALTH CARE AGENT IF YOU ARE COMFORTABLE GIVING THAT PERSON 11
BROAD AND SWEEPING POWERS TO MAKE HEALTH CARE DECISIONS FOR 12
YOU. THERE IS NO LEGAL REQUIREMENT THAT ANYONE EXECUTE A 13
HEALTH CARE POWER OF ATTORNEY. 14
15
EXPLANATION: You have the right to name someone to make health care decisions for you 16
when you cannot make or communicate those decisions. This form may be used to create a health 17
care power of attorney, and meets the requirements of North Carolina law. However, you are 18
not required to use this form, and North Carolin a law allows the use of other forms that meet 19
certain requirements. If you prepare your own health care power of attorney, you should be very 20
careful to make sure it is consistent with North Carolina law. 21
22
This document gives the person you designate as your health care agent broad powers to make 23
health care decisions for you when you cannot make the decision yourself or cannot communicate 24
your decision to other people. You should discuss your wishes concern ing life -prolonging 25
measures, mental health treatment, and other health care decisions with your health care agent. 26
Except to the extent that you express specific limitations or restrictions in this form, your health 27
care agent may make any health care decision you could make yourself. 28
29
This form does not impose a duty on your health care agent to exercise granted powers, but when 30
a power is exercised, your health care agent will be obligated to use due care to act in your best 31
interests and in accordance with this document. 32
33
This Health Care Power of Attorney form is intended to be valid in any jurisdiction in which it 34
is presented, but places outside North Carolina may impose requirements that this form does not 35
meet. 36
37
If you want to use this form, you must complete it, sign it, and have your signature witnessed by 38
two qualified witnesses and proved by a notary public. Follow the instructions about which 39
choices you can initial very carefully. Do not sign this form until two witnesses and a notary 40
public are present to watch you sign it. You then should give a copy to your health care agent 41
and to any alternates you name. You should consider filing it with the Advance Health Care 42
Directive Registry maintained by the North Carolina Secretary of State: 43
http://www.nclifelinks.org/ahcdr/State. 44
45
1. Designation of Health Care Agent. 46
47
I, __________________, being of sound mind, hereby appoint the following person(s) to serve 48
as my health care agent(s) to act for me and in my name (in any way I could act in person) t o 49
make health care decisions for me as authorized in this document. My designated health care 50
agent(s) shall serve alone, in the order named. 51
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House Bill 349-Fourth Edition Page 3
1
A. Name: _______________________ Home Telephone: _______________ 2
Home Address: _______________________ Work Telephone: _______________ 3
____________________________________ Cellular Telephone: _______________ 4
5
B. Name: _______________________ Home Telephone: _______________ 6
Home Address: _______________________ Work Telephone: _______________ 7
____________________________________ Cellular Telephone: _______________ 8
9
C. Name: _______________________ Home Telephone: _______________ 10
Home Address: _______________________ Work Telephone: _______________ 11
____________________________________ Cellular Telephone: _______________ 12
13
Any successor health care agent designated shall be vested with the same power and duties as if 14
originally named as my health care agent, and shall serve any time his or her predecessor is not 15
reasonably available or is unwilling or unable to serve in that capacity. 16
17
2. Effectiveness of Appointment. 18
19
My designation of a health care agent expires only when I revoke it. Absent revocation, the 20
authority granted in this document shall become effective when and if one of the physician(s) 21
listed below determines that I lack capacity to make or communicate decisions relating to my 22
health care, and will continue in effect during that incapacity, or until my death, except if I 23
authorize my health care agent to exercise my rights with respect to anatomical gifts, autopsy, or 24
disposition of my remains, this authority will continue after my death to the extent necessary to 25
exercise that authority. 26
27
1. _______________________ (Physician) 28
29
2. _______________________ (Physician) 30
31
If I have not designated a physician, or no physician(s) named above is reasonably available, the 32
determination that I lack capacity to make or communicate decisions relating to my health care 33
shall be made by my attending physician. 34
35
3. Revocation. 36
37
Any time while I am competent, I may revoke this power of attorney in a writing I sign or by 38
communicating my intent to revoke, in any clear and consistent manner, to my health care agent 39
or my health care provider. 40
41
4. General Statement of Authority Granted. 42
43
Subject to any restrictions set forth in Section 5 below, I grant to my health care agent full power 44
and authority to make and carry out all health care decisions for me. These decisions include, but 45
are not limited to: 46
47
A. Requesting, reviewing, and receiving any information, verbal or written, 48
regarding my physical or mental health, including, but not limited to, medical 49
and hospital records, and to consent to the disclosure of this information. 50
51
General Assembly Of North Carolina Session 2025
Page 4 House Bill 349-Fourth Edition
B. Employing or discharging my health care providers. 1
2
C. Consenting to and authorizing my admission to and discharge from a hospital, 3
nursing or convalescent home, hospice, long-term care facility, or other health 4
care facility. 5
6
D. Consenting to and authorizing my admission to and retention in a facility for 7
the care or treatment of mental illness. 8
9
E. Consenting to and authorizing the administration of medications for mental 10
health treatment and electroconvulsive treatment (ECT) commonly referred to 11
as "shock treatment." 12
13
F. Giving consent for, withdrawing consent for, or withholding consent for, 14
X-ray, anesthesia, medication, surgery, and all other diagnostic and treatment 15
procedures ordered by or under the authorization of a licensed physician, 16
dentist, podiatrist, or other health care provider. This authorization 17
specifically includes the power to consent to measures for relief of pain. 18
19
G. Authorizing the withholding or withdrawal of life-prolonging measures. 20
21
H. Providing my medical information at the request of any individual acting as 22
my attorney -in-fact under a durable power of attorney or as a Trustee or 23
successor Trustee under any Trust Agreement of which I am a Grantor or 24
Trustee, or at the request of any other individual whom my health care agent 25
believes should have such information. I desire that such information be 26
provided whenever it would expedite the prompt and proper handling of my 27
affairs or the affairs of any person or entity for which I have some 28
responsibility. In addition, I authorize my health care agent to take any and all 29
legal steps necessary to ensure compli ance with my instructions providing 30
access to my protected health information. Such steps shall include resorting 31
to any and all legal procedures in and out of courts as may be necessary to 32
enforce my rights under the law and shall include attempting to re cover 33
attorneys' fees against anyone who does not comply with this health care 34
power of attorney. 35
36
I. To the extent I have not already made valid and enforceable arrangements 37
during my lifetime that have not been revoked, exercising any right I may 38
have to authorize an autopsy or direct the disposition of my remains. 39
40
J. Taking any lawful actions that may be necessary to carry out these decisions, 41
including, but not limited to: (i) signing, executing, delivering, and 42
acknowledging any agreement, release, authorization, or other document that 43
may be necessary, desirable, convenient, or proper in order to exercise and 44
carry out any of these powers; (ii) granting releases of liability to medical 45
providers or others; and (iii) incurring reasonable costs on my b ehalf related 46
to exercising these powers, provided that this health care power of attorney 47
shall not give my health care agent general authority over my property or 48
financial affairs. 49
50
5. Special Provisions and Limitations. 51
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House Bill 349-Fourth Edition Page 5
1
(Notice: The authority granted in this document is intended to be as broad as possible so that 2
your health care agent will have authority to make any decisions you could make to obtain or 3
terminate any type of health care treatment or service. If you wish to limit the scope of your 4
health care agent's powers, you may do so in this section. If none of the following are initialed, 5
there will be no special limitations on your agent's authority.) 6
7
A. Limitations about Artificial Nutrition or Hydration: In exercising the 8
authority to make health care decisions on my behalf, my health care 9
agent: 10
______________ shall NOT have the authority to withhold artificial nutrition 11
(Initial) (such as through tubes) OR may exercise that authority only 12
in accordance with the following special provisions: 13
__________________________________________________ 14
__________________________________________________ 15
16
______________ shall NOT have the authority to withhold artificial hydration 17
(Initial) (such as through tubes) OR may exercise that authori ty only 18
in accordance with the following special provisions: 19
__________________________________________________ 20
__________________________________________________ 21
NOTE: If you initial either block but do not insert any special 22
provisions, your health care agent shall have NO AUTHORITY 23
to withhold artificial nutrition or hydration. 24
25
______________ B. Limitations Concerning Health Care Decisions. In exercising 26
(Initial) the authority to make health care decisions on my behalf, the 27
authority of my health care agent is subject to the following 28
special provisions: (Here you may include any specific 29
provisions you deem appropriate such as: your own definition 30
of when life -prolonging measures should be withheld or 31
discontinued, or inst ructions to refuse any specific types of 32
treatment that are inconsistent with your religious beliefs, or 33
are unacceptable to you for any other reason.) 34
__________________________________________________ 35
__________________________________________________ 36
NOTE: DO NOT initial unless you insert a limitation. 37
38
______________ C. Limitations Concerning Mental Health Decisions. In 39
(Initial) exercising the authority to make mental health decisions on 40
my behalf, the authority of my health care agent is subject to 41
the following special provisions: (Here you may include any 42
specific provisions you deem appropriate such as: limiting 43
the grant of authority to make only mental health treatment 44
decisions, your own instructions regarding th e administration 45
or withholding of psychotropic medications and 46
electroconvulsive treatment (ECT), instructions regarding 47
your admission to and retention in a health care facility for 48
mental health treatment, or instructions to refuse any s pecific 49
types of treatment that are unacceptable to you.) 50
__________________________________________________ 51
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__________________________________________________ 1
NOTE: DO NOT initial unless you insert a limitation. 2
3
______________ D. Advance Instructio n for Mental Health Treatment. (Notice: 4
(Initial) This health care power of attorney may incorporate or be 5
combined with an advance instruction for mental health 6
treatment, executed in accordance with Part 2 of Article 3 of 7
Chapter 122C of t he General Statutes, which you may use to 8
state your instructions regarding mental health treatment in 9
the event you lack capacity to make or communicate mental 10
health treatment decisions. Because your health care agent's 11
decisions must be consistent with any statements you have 12
expressed in an advance instruction, you should indicate here 13
whether you have executed an advance instruction for mental 14
health treatment): 15
__________________________________________________ 16
__________________________________________________ 17
NOTE: DO NOT initial unless you insert a limitation. 18
19
______________ E. Autopsy and Disposition of Remains. In exercising the 20
(Initial) authority to make decisions regarding autopsy and disposition 21
of remains on my behalf, the authority of my health care agent 22
is subject to the following special provisions and limitations. 23
(Here you may include any specific limitations you deem 24
appropriate such as: limiting the grant of authority and t he 25
scope of authority, or instructions regarding burial or 26
cremation): 27
__________________________________________________ 28
__________________________________________________ 29
NOTE: DO NOT initial unless you insert a limitation. 30
31
6. Organ Donation. 32
33
To the extent I have not already made valid and enforceable arrangements during my lifetime 34
that have not been revoked, my health care agent may exercise any right I may have to: 35
36
______________ donate any needed organs or parts; or 37
(Initial) 38
______________ donate only the following organs or parts: 39
(Initial) 40
__________________________________________________ 41
NOTE: DO NOT INITIAL BOTH BLOCKS ABOVE. 42
43
______________ donate my body for anatomical study if needed. 44
(Initial) 45
______________ In exercising the authority to make donations, my health care 46
(Initial) agent is subject to the following special provisions and 47
limitations: (Here you may include any specific limitations 48
you deem appropriate such as: limiting the grant of authorit y 49
and the scope of authority, or instructions regarding gifts of 50
the body or body parts.) 51
General Assembly Of North Carolina Session 2025
House Bill 349-Fourth Edition Page 7
__________________________________________________ 1
__________________________________________________ 2
__________________________________________________ 3
4
NOTE: DO NOT initial unless you insert a limitation. 5
6
NOTE: NO AUTHORITY FOR ORGAN DONATION IS GRANTED IN 7
THIS INSTRUMENT WITHOUT YOUR INITIALS. 8
9
7. Guardianship Provision. 10
11
If it becomes necessary for a court to appoint a guardian of my person, I nominate the persons 12
designated in Section 1, in the order named, to be the guardian of my person, to serve without 13
bond or security. The guardian shall act consistently with G.S. 35A-1201(a)(5). 14
15
8. Reliance of Third Parties on Health Care Agent. 16
17
A. No person who relies in good faith upon the authority of or any representations 18
by my health care agent shall be liable to me, my estate, my heirs, successors, 19
assigns, or personal representatives, for actions or omissions in reliance on 20
that authority or those representations. 21
B. The powers conferred on my health care agent by this document may be 22
exercised by my health care agent alone, and my health care agent's signature 23
or action taken under the authority granted in this document may be accepted 24
by persons as fully authorized by me and with the same force and effect as if 25
I were personally present, competent, and acting on my own behalf. All acts 26
performed in good faith by my health care agent pursuant to this power of 27
attorney are done with my consent and shall have the same validity and effect 28
as if I were present and exercised the powers myself, and shall inure to the 29
benefit of and bind me, my estate, my heirs, successors, assigns, and personal 30
representatives. The authority of my health care agent pursuant to th is power 31
of attorney shall be superior to and binding upon my family, relatives, friends, 32
and others. 33
34
9. Miscellaneous Provisions. 35
36
A. Revocation of Prior Powers of Attorney. I revoke any prior health care power 37
of attorney. The preceding sentence is not intended to revoke any general 38
powers of attorney, some of the provisions of which may relate to health care; 39
however, this power of attorney shall take precedence over any health care 40
provisions in any valid general power of attorney I have not revoked. 41
42
B. Jurisdiction, Severability, and Durability. This Health Care Power of Attorney 43
is intended to be valid in any jurisdiction in which it is presented. The powers 44
delegated under this power of attorney are severable, so that the invalidity of 45
one or more powers shall not affect any others. This power of attorney shall 46
not be affected or revoked by my incapacity or mental incompetence. 47
48
C. Health Care Agent Not Liable. My health care agent and my health care 49
agent's estate, heirs, successors, and assigns ar e hereby released and forever 50
discharged by me, my estate, my heirs, successors, assigns, and personal 51
General Assembly Of North Carolina Session 2025
Page 8 House Bill 349-Fourth Edition
representatives from all liability and from all claims or demands of all kinds 1
arising out of my health care agent's acts or omissions, except for my hea lth 2
care agent's willful misconduct or gross negligence. 3
4
D. No Civil or Criminal Liability. No act or omission of my health care agent, or 5
of any other person, entity, institution, or facility acting in good faith in 6
reliance on the authority of my health care agent pursuant to this Health Care 7
Power of Attorney shall be considered suicide, nor the cause of my death for 8
any civil or criminal purposes, nor shall it be considered unprofessional 9
conduct or as lack of professional competence. Any person, entity, institution, 10
or facility against whom criminal or civil liability is asserted because of 11
conduct authorized by this Health Care Power of Attorney may interpose this 12
document as a defense. 13
14
E. Reimbursement. My health care agent shall be entitled to reim bursement for 15
all reasonable expenses incurred as a result of carrying out any provision of 16
this directive. 17
18
By signing here, I indicate that I am mentally alert and competent, fully informed as to the 19
contents of this document, and understand the full imp ort of this grant of powers to my health 20
care agent. 21
22
This the _____ day of ______________, 20____. 23
24
________________________(SEAL) 25
26
I hereby state that the principal, _______________, being of sound mind, signed (or directed 27
another to sign on the princi pal's behalf) the foregoing health care power of attorney in my 28
presence, and that I am not related to the principal by blood or marriage, and I would not be 29
entitled to any portion of the estate of the principal under any existing will or codicil of the 30
principal or as an heir under the Intestate Succession Act, if the principal died on this date without 31
a will. I also state that that, unless I have received training on recognizing whether the declarant 32
meets the legal requirements for competency to execut e the health care power of attorney and 33
have been designated by my employer to serve as a witness to the execution of the health care 34
power of attorney, I am not the principal's attending physician, nor a licensed health care provider 35
or mental health treatment provider who is (1) an employee of the principal's attending physician 36
or mental health treatment provider, (2) an employee of the health facility in which the principal 37
is a patient, or (3) an employee of a nursing home or any adult care home where the principal 38
resides. I further state that I do not have any claim against the principal or the estate of the 39
principal. 40
41
Date: _____________________________ Witness: ___________________________ 42
43
Date: _____________________________ Witness: ___________________________ 44
45
________________COUNTY, _________________STATE 46
47
Sworn to (or affirmed) and subscribed before me this day by _____________________ 48
(type/print name of signer) 49
50
______________________ 51
General Assembly Of North Carolina Session 2025
House Bill 349-Fourth Edition Page 9
(type/print name of witness) 1
2
______________________ 3
(type/print name of witness) 4
5
6
Date: ___________________________ ______________________________ 7
(Official Seal) Signature of Notary Public 8
9
__________________, Notary Public 10
Printed or typed name 11
12
My commission expires: __________" 13
14
PART II. ADVANCE HEALTH CARE DIRECTIVES 15
SECTION 2.1. G.S. 90-321(c) reads as rewritten: 16
"(c) The attending physician shall follow, subject to subsections (b), (e), and (k) of this 17
section, a declaration:declaration meeting all of the following: 18
(1) That expresses a desire of the declarant that life -prolonging measures not be 19
used to prolong the declarant's life if, as specified in the declaration as to any 20
or all of the following: 21
a. The declarant has an incurable or irreversible condition that will result 22
in the declarant's death within a relatively short period of time; ortime. 23
b. The declarant becomes unconscious and, to a high degree of medical 24
certainty, will never regain consciousness; orconsciousness. 25
c. The declarant suffers from advanced dementia or any other condi tion 26
resulting in the substantial loss of cognitive ability and that loss, to a 27
high degree of medical certainty, is not reversible. 28
(2) That states that the declarant is aware that the declaration authorizes a 29
physician to withhold or discontinue the life -prolonging measures; 30
andmeasures. 31
(3) Except as provided in G.S. 90-321.1, that has been signed by the declarant in 32
the presence of two witnesses who believe the declarant to be of sound mind 33
and who state that they (i) are all of the following are true: 34
a. The witness is not related within the third degree to the declarant or to 35
the declarant's spouse, (ii) do spouse. 36
b. The witness does not know or have a reasonable expectation that they 37
he or she would be entitled to any portion of the estate of the declarant 38
upon the declarant's death under any will of the declarant or codicil 39
thereto then existing or under the Intestate Succession Act as it then 40
provides, (iii) are not provides. 41
c. The witness does not have a claim against any portion of the estate of 42
the declarant at the time of the declaration. 43
d. The witness is not the attending physician, a licensed health care 44
providers provider who are paid employees is a paid employee of the 45
attending physician, a paid employees employee of a health facility in 46
which the declarant is a patient, or a paid employees employee of a 47
nursing home or any adult care home in which the declarant 48
resides,and (iv) do not have a claim against any po rtion of the estate 49
of the declarant at the time of the declaration; andresides, unless the 50
witness has both (i) received training on recognizing whether the 51
General Assembly Of North Carolina Session 2025
Page 10 House Bill 349-Fourth Edition
declarant meets the legal requirements for competency to execute the 1
Advanced Directive for a Natural Death and (ii) been designated by 2
his or her employer to serve as a witness t o the execution of the 3
Advanced Directive for a Natural Death. 4
(4) That has been proved before a clerk or assistant clerk of superior court, or a 5
notary public who certifies substantially as set out in subsection (d1) of this 6
section. A notary who takes the acknowledgement may but is not required to 7
be a paid employee of the attending physician, a paid employee of a health 8
facility in which the declarant is a patient, or a paid employee of a nursing 9
home or any adult care home in which the declarant resides." 10
SECTION 2.2. G.S. 90-321(d1) reads as rewritten: 11
"(d1) The following form is specifically determined to meet the requirements of subsection 12
(c) of this section: 13
14
ADVANCE DIRECTIVE FOR A NATURAL DEATH ("LIVING WILL") 15
16
NOTE: YOU SHOULD USE THIS DOCUMENT TO GIVE YOUR HEALTH CARE 17
PROVIDERS INSTRUCTIONS TO WITHHOLD OR WITHDRAW 18
LIFE-PROLONGING MEASURES IN CERTAIN SITUATIONS. THERE IS NO LEGAL 19
REQUIREMENT THAT ANYONE EXECUTE A LIVING WILL. 20
21
GENERAL INSTRUCTIONS: You can use this Advance Directive ("Living Will") form to give 22
instructions for the future if you want your health care providers to withhold or withdraw 23
life-prolonging measures in certain situations. You should talk to your doctor about what these 24
terms mean. The Living Will states what choices you w ould have made for yourself if you were 25
able to communicate. Talk to your family members, friends, and others you trust about your 26
choices. Also, it is a good idea to talk with professionals such as your doctors, clergypersons, 27
and lawyers before you complete and sign this Living Will. 28
29
You do not have to use this form to give those instructions, but if you create your own Advance 30
Directive you need to be very careful to ensure that it is consistent with North Carolina law. 31
32
This Living Will form is intended to be valid in any jurisdiction in which it is presented, but places 33
outside North Carolina may impose requirements that this form does not meet. 34
35
If you want to use this form, you must complete it, sign it, and have your signature witnessed by 36
two qualified witnesses and proved by a notary public. Follow the instructions about which 37
choices you can initial very carefully. Do not sign this form until two witnesses and a notary 38
public are present to watch you sign it. You then should consider giving a copy to your primary 39
physician and/or a trusted relative, and should consider filing it with the Advanced Health Care 40
Directive Registry maintained by the North Carolina Secretary of State: 41
http://www.nclifelinks.org/ahcdr/State: 42
43
My Desire for a Natural Death 44
45
I, ____________________, being of sound mind, desire that, as specified below, my life not be 46
prolonged by life-prolonging measures: 47
48
1. When My Directives Apply 49
50
General Assembly Of North Carolina Session 2025
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My directions about prolonging my life shall apply IF my attending physician determines 1
that I lack capacity to make or communicate health care decisions and: 2
3
NOTE: YOU MAY INITIAL ANY AND ALL OF THESE CHOICES. 4
5
_________ I have an incurable or irreversible condition that will result 6
(Initial) in my death within a relatively short period of time. 7
8
_________ I become unconscious and my health care providers 9
(Initial) determine that, to a high degree of medical certainty, I will 10
never regain my consciousness. 11
12
_________ I suffer from advanced dementia or any other condition 13
(Initial) which results in the substantial loss of my cognitive ability 14
and my health care providers determine that, to a high 15
degree of medical certainty, this loss is not reversible. 16
17
2. These are My Directives about Prolonging My Life: 18
19
In those situations I have initialed in Section 1, I direct that my health care providers: 20
21
NOTE: INITIAL ONLY IN ONE PLACE. 22
23
_________ may withhold or withdraw life-prolonging measures. 24
(Initial) 25
26
_________ shall withhold or withdraw life-prolonging measures. 27
(Initial) 28
29
3. Exceptions – "Artificial Nutrition or Hydration" 30
31
NOTE: INITIAL ONLY IF YOU WANT TO MAKE EXCEPTIONS TO YOUR 32
INSTRUCTIONS IN PARAGRAPH 2. 33
34
EVEN THOUGH I do not want my life prolonged in those situations I have initialed in 35
Section 1: 36
_________ I DO want to receive BOTH artificial hydration AND 37
(Initial) artificial nutrition (for example, through tubes) in those 38
situations. 39
40
NOTE: DO NOT INITIAL THIS BLOCK IF ONE OF THE 41
BLOCKS BELOW IS INITIALED. 42
43
_________I DO want to receive ONLY artificial hydration (for 44
(Initial) example, through tubes) in those situations. 45
46
NOTE: DO NOT INITIAL THE BLOCK ABOVE OR 47
BELOW IF THIS BLOCK IS INITIALED. 48
49
_________ I DO want to receive ONLY artificial nutrition (for 50
(Initial) example, through tubes) in those situations. 51
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1
NOTE: DO NOT INITIAL EITHER OF THE TWO 2
BLOCKS ABOVE IF THIS BLOCK IS INITIALED. 3
4
4. I Wish to be Made as Comfortable as Possible 5
6
I direct that my health care providers take reasonable steps to keep me as clean, 7
comfortable, and free of pain as possible so that my dignity is maintained, even though 8
this care may hasten my death. 9
10
5. I Understand my Advance Directive 11
12
I am aware and understand that this document directs certain life-prolonging measures to 13
be withheld or discontinued in accordance with my advance instructions. 14
15
6. If I have an Available Health Care Agent 16
17
If I have appointed a health care agent by executing a health care power of attorney or 18
similar instrument, and that health care agent is acting and available and gives instructions 19
that differ from this Advance Directive, then I direct that: 20
21
_________ Follow Advance Directive: This Advance Directive will 22
(Initial) override instructions my health care agent gives about 23
prolonging my life. 24
25
_________ Follow Health Care A gent: My health care agent has 26
(Initial) authority to override this Advance Directive. 27
28
NOTE: DO NOT INITIAL BOTH BLOCKS. IF YOU DO NOT INITIAL EITHER 29
BOX, THEN YOUR HEALTH CARE PROVIDERS WILL FOLLOW THIS 30
ADVANCE DIRECTIVE AND IGNORE THE INSTRUCTIONS OF YOUR HEALTH 31
CARE AGENT ABOUT PROLONGING YOUR LIFE. 32
33
7. My Health Care Providers May Rely on this Directive 34
35
My health care providers shall not be liable to me or to my family, my estate, my heirs, 36
or my personal representative for following the instruction s I give in this instrument. 37
Following my directions shall not be considered suicide, or the cause of my death, or 38
malpractice or unprofessional conduct. If I have revoked this instrument but my health 39
care providers do not know that I have done so, and th ey follow the instructions in this 40
instrument in good faith, they shall be entitled to the same protections to which they 41
would have been entitled if the instrument had not been revoked. 42
43
8. I Want this Directive to be Effective Anywhere 44
45
I intend that this Advance Directive be followed by any health care provider in any place. 46
47
9. I have the Right to Revoke this Advance Directive 48
49
I understand that at any time I may revoke this Advance Directive in a writing I sign or 50
by communicating in any clear and consistent manner my intent to revoke it to my 51
General Assembly Of North Carolina Session 2025
House Bill 349-Fourth Edition Page 13
attending physician. I understand that if I revoke this instrument I should try to destroy 1
all copies of it. 2
3
This the ________ day of ____________, _________. 4
5
___________________________________ 6
Print Name __________________________ 7
8
I hereby state that the declarant, ______________________, being of sound mind, signed (or 9
directed another to sign on declarant's behalf) the foregoing Advance Directive for a Natural 10
Death in my presence, and that I am not related to the declarant by blood or marriage, and I would 11
not be entitled to any portion of the estate of the declarant under any existing will or codicil of 12
the declarant or as an heir under the Intestate Succession Act, if the declarant died on this date 13
without a will. I also state that that, unless I have received training on recognizing whether the 14
declarant meets the legal requirements for competency to execute the Advanced Directive for a 15
Natural Death and have been designated by my employer to serve as a witness to the execution 16
of the Advanced Directive for a Natural Death, I am not the declarant's attending physician, nor 17
a licensed health care provider who is (1) an employee of the declarant's attending physician, (2) 18
nor an employee of the health facility in which the declarant is a patient, or (3) an employee of a 19
nursing home or any adult care home where the declarant resides. I further state that I do not have 20
any claim against the declarant or the estate of the declarant. 21
22
Date: _____________________________ Witness: ___________________________ 23
24
Date: _____________________________ Witness: ___________________________ 25
26
________________COUNTY, _________________STATE 27
28
Sworn to (or affirmed) and subscribed before me this day by _____________________ 29
(type/print name of declarant) 30
31
________________________ 32
(type/print name of witness) 33
34
________________________ 35
(type/print name of witness) 36
37
Date ___________________________ ______________________________ 38
(Official Seal) Signature of Notary Public 39
40
__________________, Notary Public 41
Printed or typed name 42
43
My commission expires: _________" 44
45
PART III. ELECTRONIC FILING OF HEALTH CARE POWERS OF ATTORNEY AND 46
ADVANCE HEALTH CARE DIRECTIVES WITH THE NORTH CAROLINA 47
SECRETARY OF STATE 48
SECTION 3.1. G.S. 130A-466 reads as rewritten: 49
"§ 130A-466. Filing requirements. 50
General Assembly Of North Carolina Session 2025
Page 14 House Bill 349-Fourth Edition
(a) A person may submit any of the following documents and the revocations of these 1
documents to the Secretary of State in electronic or hard copy format for filing in the Advance 2
Health Care Directive Registry established pursuant to this Article: 3
(1) A health care power of attorney under Article 3 of Chapter 32A of the General 4
Statutes. 5
(2) A declaration of a desire for a natural death under Article 23 of Chapter 90 of 6
the General Statutes. 7
(3) An advance instruction for mental health treatment under Part 2 of Article 3 8
of Chapter 122C of the General Statutes. 9
(4) A declaration of an anatomical gift under Part 3A of Article 16 of Chapter 10
130A of the General Statutes. 11
(5) A Health Insurance Portability and Accountability Act (HIPAA) waiver. 12
(b) Any document and any revocation of a document submitted for filing in the registry 13
shall be notarized regardless of whether notarization is required for its validity. This subsection 14
does not apply to a declaration of an anatomical gift described in subdivision (a)(4) of this 15
section. 16
(c) The document may be submitted for filing only by the person who executed the 17
document. 18
(d) The person who submits the document shall supply a return address. 19
(e) The document shall be accompanied by any fee required by this Article." 20
SECTION 3.2. G.S. 130A-468 reads as rewritten: 21
"§ 130A-468. Filing of documents with the registry. 22
(a) When the Secretary of State receives a hard copy of a document that may be filed 23
with the registry pursuant to this Article, the Secretary shall create a digital reproduction of that 24
document and enter the reproduced document into the registry database. When the Secretary of 25
State receives a document in electronic format that may be filed with the registry pursuant to this 26
Article, the Secretary shall enter that document into the registry database. The Secretary is not 27
required to review a document to ensure that it complies with the particular statutory 28
requirements applicable to the document. Each document entered into the registry database shall 29
be assigned a unique file number and password. 30
(b) Upon entering the a reproduced hard copy of a document into the registry database, 31
the Secretary shall return the original hard copy of the document and a wallet-size card containing 32
the document's file number and password to the person who submitted the document. Upon 33
entering into the registry database a document that was received in electronic format, the 34
Secretary shall send a wallet -size card containing the document 's file number and password to 35
the person who submitted the document. 36
(c) When the Secretary of State receives a revocation of a document that is filed with the 37
registry and that document's file number and password, or a request to remove that document 38
from the registry without its revocation, the Secretary shall delete that document from the registry 39
database. 40
(c1) The Secretary of State may remove documents of deceased registrants from the 41
registry upon notification of death in writing in a form acceptable to the Secretary of State. 42
(d) The Secretary of State's entry of a document into, or removal of a document from, the 43
registry database does not do any of the following: 44
(1) Affect the validity of the document in whole or in part. 45
(2) Relate to the accuracy of information contained in the document. 46
(3) Create a presumption regarding the validity of the document, regarding the 47
accuracy of information contained in the document, or that the statutory 48
requirements for the document have been met." 49
50
PART IV. EFFECTIVE DATE 51
General Assembly Of North Carolina Session 2025
House Bill 349-Fourth Edition Page 15
SECTION 4. This act becomes effective October 1, 2026. 1