The following information about this VA form comes from the VA forms database, and any changes are updated here nightly. Contact the form administration for further information.
Link to form
https://www.va.gov/vaforms/medical/pdf/VA_Form_10-0137_FILL.pdf
Form number
10-0137
Row ID
3141
Form title
VA Advance Directive: Durable Power of Attorney for Health Care and Living Will
Issue date
Revision date
Form administration
VHA
Number of pages
6
Deleted
False
Form name
VA Advance Directive: Durable Power of Attorney for Health Care and Living Will
Form Language
English
Related to
VA health care
When to use

Use VA Form 10-0137 to give specific people permission to make health care decisions for you, and to let VA health care providers know your wishes for medical, mental health, long-term, and other types of care.

Related forms
About VA Form 10-0137A
Helpful links
Patient rights and responsibilities
Read about your basic rights and responsibilities when you receive care at a VA health facility or live in a VA community center.