<< Back To Home Page     <<Brief History                                  PHOTO>>

Psych Eval   History & Physical   Discharge Summary   Chemistries   CBC   CXR   UA   MRI

Living Will / Medical Treatment Plan   EKG   Graphic Chart   Nursing Admission Assessment

Physician's Orders   Progress Notes   Nursing Staff Notes   Medication Administration Record

Phone Intake Data   Overnight Oximetry




                                                         Ennis Alldredge        Original of Living Will Below

I, ENNIS Alldredge, a resident of the Town of Oak City, County of Millard, State of Utah, being of sound and disposing mind, memory and understanding, do hereby willfully and voluntarily make, publish and declare this to be my LIVING WILL, making known my desire that my life shall not be artificially prolonged under the circumstances set forth below, and do hereby declare:

1. This instrument is directed to my family, my physician(s), my attorney, my clergyman, any medical facility in whose care I happen to be, and to any individual who may become responsible for my health, welfare or affairs.

2. Death is as much a reality as birth, growth, maturity and old age. It is the one certainty of life. Let this statement stand as an expression of my wishes now that I am still of sound mind, for the time when I may no longer take part in decisions for my own future.

3. If at any time I should have a terminal condition and my attending physician has determined that there can be no recovery from such condition and my death is imminent, where the application of life-prolonging procedures and "heroic measures" would serve only to artificially prolong the dying process, I direct that such procedures be withheld or withdrawn, and that I be permitted to die naturally. I do not fear death itself as much as the indignities of deterioration, dependence and hopeless pain. I therefore ask that medication be mercifully administered to me and that any medical procedures be performed on me which are deemed necessary to provide me with comfort, care or to alleviate pain.

4. In the absence of my ability to give directions regarding the use of such life-prolonging procedures, it is my intention that this declaration shall be honored by my family and physician as the final expression of my legal right to refuse medical or surgical treatment and accept the consequences for such refusal.

5. In the event that I am diagnosed as comatose, incompetent, or otherwise mentally or physically incapable of communication, I appoint Bradley Alldredge, and Myrna A. Gromwald (respectively and individually in that order) to make binding decisions concerning my medical treatment.

6. I understand the full import of this declaration and I am emotionally and mentally competent to make this declaration. I hope you, who care for me, will feel morally bound to follow its mandate. I recognize that this appears to place a heavy responsibility upon you, but it is with the intention of relieving you of such responsibility and of placing it upon myself, in accordance with my strong convictions, that this statement is made.

IN WITNESS WHEREOF, I have hereunto subscribed my name at Oak City, Utah this 30th day of July, 1993, in the presence of the subscribing witnesses whom I have requested to become attesting witnesses hereto.

(Signed) Ennis Alldredge


The declarant, ENNIS Alldredge is known to me and I believe him to be of sound mind.

(Signed) Betty Jeffrey                      Delta, Utah

Witness                                           Address

(Signed) Nancy Oppenheim             Delta, Utah

Witness                                           Address



: ss:


 Subscribed, sworn to and acknowledge before me by ENNIS Alldredge, the

declarant, and subscribed and sworn to before me by

(Signed) Nancy Oppenheimer and (Signed) Betty Jeffery ,

witnesses, this 30th day of July, A.D. 1993.

(Signed) Claudia Terrell

[Notary Public Seal] Notary Public

 Copies of this instrument have been given to:

 Receipt and acknowledged (Name, Address & date):

(Signed) Bradley Alldredge

(Signed) Myrna Gronwald

Psych Eval   History & Physical   Discharge Summary

Living Will / Medical Treatment Plan

Physician's Orders   Progress Notes   Nursing Staff Notes

<< Back To Home Page