Living Will and health care Power of Attorney
—Order Form
In Pennsylvania, you have the legal and ethical right to make your own decisions about the type of health care you want. As long as you are well enough, your physicians will involve you directly in making decisions about your medical treatment.

You should plan ahead, however, in case you become unable to make or communicate decisions about your medical care. You can tell your family and physicians how you want to be treated by preparing an Advance Directive, commonly called a Living Will.


Send your check to:

Allegheny County Medical Society
713 Ridge Avenue
Pittsburgh, PA 15212-6098

Ship to [Please PRINT or TYPE]:

Name________________________________________
Address______________________________________
_____________________________________________
City, State, Zip_________________________________
Phone (_______)_______________________________

For more information, call
(412) 321-5030

Number of Copies: Cost: Total Cost
1-9 $2.50 each
10 $20
25 $30
75 $45
125 $60
200 $80
350 $125
500 $150
1,000 $250
Total Amount Due:


This form developed and approved by:
Allegheny County Bar AssociationAllegheny County Medical Society


Back to Living Will Information

Tuesday, January 20, 2004