When you receive this form预立医疗指示的要求因州而异。请从您所在州的政府网站获取适用于您所在州的表格——请参阅/usa/directory/的州目录以获取州卫生部门链接。医院可能在入院时提供该表格。您无需等待住院——只要您具有决策能力，可以随时填写预立医疗指示。
What to bring or have ready完成预立医疗指示通常需要两名成年见证人，他们不得是您的医疗代理人、医疗提供者或您遗产的受益人。一些州还需要公证。签署前请查看您所在州的要求。
本人信息 / Principal Information
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中文
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Principal Name
本人姓名
The legal name of the person making this advance directive — the individual whose healthcare wishes are being recorded.
制定本预立医疗指示的人的法定姓名——即其医疗意愿被记录的个人。
Date of Birth
出生日期
The principal's date of birth, used to identify this individual in medical records and confirm they are an adult of legal age to execute this document.
本人的出生日期，用于在医疗记录中识别该人，并确认其是具有法定年龄的成年人，有权执行本文件。
Current Address
现居地址
The principal's current home address. Some states use this to establish residency and confirm the correct state form is being used.
The full legal name of the person you are naming to make healthcare decisions on your behalf if you become unable to do so. This person is often called a health care proxy, health care agent, or durable power of attorney for healthcare.
Contact information for your health care agent so that medical providers can reach them quickly in an emergency.
您的医疗代理人的联系信息，以便医疗提供者在紧急情况下能够迅速联系到他们。
Alternate Agent Name
备用代理人姓名
An alternate or successor agent who will act if your primary agent is unavailable, unwilling, or unable to serve. Naming an alternate helps ensure your wishes can be honored.
Contact information for your alternate health care agent so they can be reached if the primary agent cannot be contacted.
您的备用医疗代理人的联系信息，以便在无法联系主要代理人时能够联系到他们。
治疗偏好摘要 / Treatment Preferences Summary
English
中文
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中文 — Help
General Treatment Preference Statement
总体治疗偏好声明
A free-text space for you to describe your general wishes regarding medical treatment — for example, under what circumstances you would or would not want life-sustaining treatment, what matters most to you in your care, or other guidance for your agent and providers. Write in your own words. Your specific state form may structure this section differently.
An adult witness who signs to confirm they observed the principal signing this document voluntarily. State requirements vary, but witnesses generally may not be your health care agent, your healthcare provider, or a beneficiary of your estate.
A second adult witness, subject to the same requirements as Witness 1. Having two witnesses is standard across most states, though the specific eligibility rules differ. Check your state's advance directive requirements.
Some states require a notary public to witness and stamp the document in addition to the two witnesses. Other states accept witnesses alone. This field indicates whether notarization applies — check your specific state's advance directive law to confirm.