Advance Directive Checklist: Every Step From Choosing an Agent to Storing the Forms

Most advance directives fail in one of two ways: they were never signed correctly, or they were signed correctly and then disappeared into a drawer nobody can find. The form itself takes less than an hour. What actually protects you is everything around the form — choosing the right agent, having the conversation, executing it to your state's rules, and getting copies into the right hands.

This checklist covers the whole process, start to finish. Examples reference Wyoming law (the Wyoming Health Care Decisions Act, W.S. § 35-22-401 et seq.), but the sequence applies anywhere — just swap in your own state's execution rules.

Step 1: Choose Your Agent (and a Backup)

Your health care agent makes medical decisions when you can't. This choice matters more than anything you write down.

• [ ] Pick someone who can get to a hospital fast and stay calm under pressure.
• [ ] Confirm they meet your state's eligibility rules. In Wyoming, an agent can't be an owner, operator, or employee of the residential or community care facility where you're treated, unless related to you by blood, marriage, or adoption.
• [ ] Name at least one alternate agent.
• [ ] Check your state's default surrogate hierarchy (Wyoming's is spouse → adult children → parents → grandparents → siblings → grandchildren). If the default doesn't match your choice, you need this document.

Step 2: Have the Conversation First

• [ ] Tell your agent they've been chosen and what the role involves.
• [ ] Walk through your values: what "quality of life" means to you, what outcomes you'd refuse, what you'd accept temporarily.
• [ ] Tell the rest of your family who you picked and why. Surprises at the bedside cause the worst fights — and in states like Wyoming, equal-rank relatives who disagree end up decided by majority vote.

Step 3: Write Specific Treatment Instructions

This is the "living will" portion — Part 2 of Wyoming's combined directive. Vague language ("no heroic measures") creates conflict; specifics create compliance.

• [ ] State your wishes on CPR.
• [ ] State your wishes on mechanical ventilation.
• [ ] State your wishes on artificially administered nutrition and hydration (tube feeding).
• [ ] State your wishes on comfort and palliative care.
• [ ] If relevant, add dementia-specific provisions — instructions tied to stages of cognitive decline.
• [ ] Record organ donation wishes (Part 3 in Wyoming) and name your primary physician (Part 4).

Note what your state doesn't allow: Wyoming, like most states, has no medical aid in dying statute — the legal options are refusing or withdrawing treatment.

Step 4: Execute It Correctly

Execution errors are the most common reason directives get challenged. Rules vary by state; Wyoming's require:

• [ ] Written, dated document signed while you have capacity.
• [ ] Signature notarized or witnessed by two qualified adults.
• [ ] If using witnesses, verify eligibility — in Wyoming, witnesses can't be your treating provider or its employees, your agent, or care-facility staff. Notarization avoids the question entirely.
• [ ] If you can't physically sign, direct someone to sign in your presence (permitted under W.S. § 35-22-403).

Step 5: Coordinate Other Documents

• [ ] If you're seriously ill or severely frail (life expectancy under a year), ask your clinician about a POLST — in Wyoming, the gold-cardstock WyoPOLST signed by an MD, PA, or APRN. An advance directive plans for the future; a POLST is an active medical order EMS will act on today. See our Wyoming POLST guide.
• [ ] Make sure the POLST and directive don't contradict each other.
• [ ] Pair the directive with a financial power of attorney — healthcare agents can't pay bills.

Step 6: Distribute and Store

A directive nobody can find is a directive that doesn't exist.

• [ ] Copy to your primary agent and alternate.
• [ ] Copy to your primary care doctor.
• [ ] Ask your local hospital's registration desk to add it to your file — do this before any planned surgery.
• [ ] Keep the original somewhere accessible at home. Never a safe deposit box only you can open.
• [ ] If you have a POLST, post the gold original where EMS looks: front of the refrigerator or inside the front door.

Step 7: Review and Revise

• [ ] Review after divorce (in Wyoming, divorce automatically revokes a spouse's agent appointment), a new diagnosis, a move to another state, or a family falling-out.
• [ ] Know the revocation rules: in Wyoming, treatment instructions can be revoked in any manner (oral revocations must be documented in writing promptly), but the agent appointment requires a signed writing.
• [ ] When circumstances change, re-execute a fresh directive and redistribute — cleaner than stacking amendments.

Work through these seven steps and your directive will do the one thing that matters: get honored. If you want the process packaged — state-specific execution checklists, an agent-conversation worksheet, a signing-day checklist, and a storage-and-distribution log — the Wyoming Advance Directive & Living Will Kit has all of it in one place.

See more Wyoming guides →