N.M. Stat. § 24-7A-4 (2026)

The following form may, but need not, be used to create an advance health-care
directive. The other sections of the Uniform Health-Care Decisions Act govern the effect
of this or any other writing used to create an advance health-care directive. An
individual may complete or modify all or any part of the following form:

                 "OPTIONAL ADVANCE HEALTH-CARE DIRECTIVE

                                       Explanation

   You have the right to give instructions about your own health care. You also have
the right to name someone else to make health-care decisions for you. This form lets
you do either or both of these things. It also lets you express your wishes regarding the
designation of your primary care practitioner.

    THIS FORM IS OPTIONAL. Each paragraph and word of this form is also optional. If
you use this form, you may cross out, complete or modify all or any part of it. You are
free to use a different form. If you use this form, be sure to sign it and date it.

    PART 1 of this form is a power of attorney for health care. PART 1 lets you name
another individual as agent to make health-care decisions for you if you become
incapable of making your own decisions or if you want someone else to make those
decisions for you now even though you are still capable. You may also name an
alternate agent to act for you if your first choice is not willing, able or reasonably
available to make decisions for you. Unless related to you, your agent may not be an
owner, operator or employee of a health-care institution at which you are receiving care.

    Unless the form you sign limits the authority of your agent, your agent may make all
health-care decisions for you. This form has a place for you to limit the authority of your
agent. You need not limit the authority of your agent if you wish to rely on your agent for
all health-care decisions that may have to be made. If you choose not to limit the
authority of your agent, your agent will have the right to:

  (a) consent or refuse consent to any care, treatment, service or procedure to
maintain, diagnose or otherwise affect a physical or mental condition;

   (b) select or discharge health-care practitioners and institutions;

  (c) approve or disapprove diagnostic tests, surgical procedures, programs of
medication and orders not to resuscitate; and

   (d) direct the provision, withholding or withdrawal of artificial nutrition and hydration
and all other forms of health care.

    PART 2 of this form lets you give specific instructions about any aspect of your
health care. Choices are provided for you to express your wishes regarding life-
sustaining treatment, including the provision of artificial nutrition and hydration, as well
as the provision of pain relief. In addition, you may express your wishes regarding
whether you want to make an anatomical gift of some or all of your organs and tissue.
Space is also provided for you to add to the choices you have made or for you to write
out any additional wishes.

   PART 3 of this form lets you designate a primary care practitioner to have primary
responsibility for your health care.

   After completing this form, sign and date the form at the end. It is recommended but
not required that you request two other individuals to sign as witnesses. Give a copy of
the signed and completed form to your physician, to any other health-care practitioners
you may have, to any health-care institution at which you are receiving care and to any
health-care agents you have named. You should talk to the person you have named as
agent to make sure that he or she understands your wishes and is willing to take the
responsibility.

    You have the right to revoke this advance health-care directive or replace this form
at any time.

                              *********************

                                          PART 1
                      POWER OF ATTORNEY FOR HEALTH CARE

       (1)  DESIGNATION OF AGENT: I designate the following individual as my
agent to make health-care decisions for me:

______________________________________________________________________
_____________

                            (name of individual you choose as agent)

______________________________________________________________________
_____________

(address)     (city) (state) (zip code)

______________________________________________________________________
_____________

       (home phone)          (work phone)

   If I revoke my agent's authority or if my agent is not willing, able or reasonably
available to make a health-care decision for me, I designate as my first alternate agent:

______________________________________________________________________
_____________

                     (name of individual you choose as first alternate agent)

______________________________________________________________________
_____________

(address)     (city) (state) (zip code)

______________________________________________________________________
_____________

       (home phone)          (work phone)

   If I revoke the authority of my agent and first alternate agent or if neither is willing,
able or reasonably available to make a health-care decision for me, I designate as my
second alternate agent:

______________________________________________________________________
_____________

                   (name of individual you choose as second alternate agent)
______________________________________________________________________
_____________

(address)     (city) (state) (zip code)

______________________________________________________________________
_____________

       (home phone)          (work phone)

       (2)    AGENT'S AUTHORITY: My agent is authorized to obtain and review
medical records, reports and information about me and to make all health-care
decisions for me, including decisions to provide, withhold or withdraw artificial nutrition,
hydration and all other forms of health care to keep me alive, except as I state here:

______________________________________________________________________
_____________

______________________________________________________________________
_____________

                                (Add additional sheets if needed.)

       (3)      WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: My agent's
authority becomes effective when my primary care practitioner and one other qualified
health-care professional determine that I am unable to make my own health-care
decisions. If I initial this box [ ], my agent's authority to make health-care decisions for
me takes effect immediately.

       (4)     AGENT'S OBLIGATION: My agent shall make health-care decisions for
me in accordance with this power of attorney for health care, any instructions I give in
PART 2 of this form and my other wishes to the extent known to my agent. To the
extent my wishes are unknown, my agent shall make health-care decisions for me in
accordance with what my agent determines to be in my best interest. In determining my
best interest, my agent shall consider my personal values to the extent known to my
agent.

       (5)      NOMINATION OF GUARDIAN: If a guardian of my person needs to be
appointed for me by a court, I nominate the agent designated in this form. If that agent
is not willing, able or reasonably available to act as guardian, I nominate the alternate
agents whom I have named, in the order designated.

                                           PART 2

                          INSTRUCTIONS FOR HEALTH CARE
    If you are satisfied to allow your agent to determine what is best for you in making
end-of-life decisions, you need not fill out this part of the form. If you do fill out this part
of the form, you may cross out any wording you do not want.

        (6)    END-OF-LIFE DECISIONS: If I am unable to make or communicate
decisions regarding my health care, and IF (i) I have an incurable or irreversible
condition that will result in my death within a relatively short time, OR (ii) I become
unconscious and, to a reasonable degree of medical certainty, I will not regain
consciousness, OR (iii) the likely risks and burdens of treatment would outweigh the
expected benefits, THEN I direct that my health-care practitioners and others involved in
my care provide, withhold or withdraw treatment in accordance with the choice I have
initialed below in one of the following three boxes:

[]     I CHOOSE NOT To Prolong Life

I do not want my life to be prolonged.

[]     I CHOOSE To Prolong Life

I want my life to be prolonged as long as possible within the limits of generally accepted
health-care standards.

[]     I CHOOSE To Let My Agent Decide

My agent under my power of attorney for health care may make life-sustaining
treatment decisions for me.

       (7)     ARTIFICIAL NUTRITION AND HYDRATION: If I have chosen above NOT
to prolong life, I also specify by marking my initials below:

[]     I DO NOT want artificial nutrition OR

[]     I DO want artificial nutrition.

[]     I DO NOT want artificial hydration unless required for my comfort OR

[]     I DO want artificial hydration.

      (8)     RELIEF FROM PAIN: Regardless of the choices I have made in this form
and except as I state in the following space, I direct that the best medical care possible
to keep me clean, comfortable and free of pain or discomfort be provided at all times so
that my dignity is maintained, even if this care hastens my death:

______________________________________________________________________
_____________
______________________________________________________________________
_____________

        (9) ANATOMICAL GIFT DESIGNATION: Upon my death I specify as marked
below whether I choose to make an anatomical gift of all or some of my organs or
tissue:

[]    I CHOOSE to make an anatomical gift of all of my organs or tissue to be
determined by medical suitability at the time of death, and artificial support may be
maintained long enough for organs to be removed.

[]     I CHOOSE to make a partial anatomical gift of some of my organs and tissue as
specified below, and artificial support may be maintained long enough for organs to be
removed.

______________________________________________________________________
_____________

______________________________________________________________________
_____________

[]     I REFUSE to make an anatomical gift of any of my organs or tissue.

[]     I CHOOSE to let my agent decide.

       (10) OTHER WISHES: (If you wish to write your own instructions, or if you wish
to add to the instructions you have given above, you may do so here.) I direct that:

______________________________________________________________________
_____________

______________________________________________________________________
_____________

                               (Add additional sheets if needed.)

                                         PART 3

                           PRIMARY CARE PRACTITIONER

       (11)   I designate the following as my primary care practitioner:

______________________________________________________________________
_____________

                               (name of primary care practitioner)
______________________________________________________________________
_____________

(address)     (city) (state) (zip code)

______________________________________________________________________
_____________

                                          (phone)

   If the primary care practitioner I have designated above is not willing, able or
reasonably available to act as my primary care practitioner, I designate the following as
my primary care practitioner:

______________________________________________________________________
_____________

                               (name of primary care practitioner)

______________________________________________________________________
_____________

(address)     (city) (state) (zip code)

______________________________________________________________________
_____________

                                          (phone)

                              ********************

       (12)   EFFECT OF COPY: A copy of this form has the same effect as the
original.

       (13) REVOCATION: I understand that I may revoke this OPTIONAL ADVANCE
HEALTH-CARE DIRECTIVE at any time, and that if I revoke it, I should promptly notify
my supervising health-care practitioner and any health-care institution where I am
receiving care and any others to whom I have given copies of this power of attorney. I
understand that I may revoke the designation of an agent either by a signed writing or
by personally informing the supervising health-care practitioner.

      (14)    SIGNATURES: Sign and date the form here:

 _______________________________            ___________________________________
 ___                                        ___
              (date)                                   (sign your name)
 _______________________________           ___________________________________
 ___                                       ___
                (address)                              (print your name)
 _______________________________           ___________________________________
 ___                                       ___
 (city) (state)                                  (your social security number)
 (Optional) SIGNATURES OF WITNESSES:
                First witness                    Second witness
 _______________________________ ___________________________________
 ___                              ___
                (print name)                       (print name)
 _______________________________ ___________________________________
 ___                              ___
                 (address)                          (address)
 _______________________________ ___________________________________
 ___                              ___
 (city) (state)                   (city) (state)
 _______________________________ ___________________________________
 ___                              ___
           (signature of witness)             (signature of witness)
 _______________________________ ___________________________________
 ___                              ___
                    (date)                            (date)".

History: Laws 1995, ch. 182, § 4; 1997, ch. 168, § 3; 2000, ch. 54, § 9; 2015, ch. 116, §
5.

                                    ANNOTATIONS

The 2015 amendment, effective June 19, 2015, substituted each reference to "primary
physician" with "primary care practitioner"; in the second undesignated paragraph, after
"primary", deleted "physician" and added "care practitioner"; in the seventh
undesignated paragraph, after "designate a", deleted "physician" and added "primary
care practitioner"; in the eighth undesignated paragraph, after the first occurrence of
"health-care", deleted "providers" and added "practitioners"; in Paragraph (3) of Part 1
of the form; after "primary", deleted "physician" and added "care practitioner"; in
Paragraph (6) of Part 2 of the form, after "health-care", deleted "providers" and added
"practitioners"; in Part 3 of the form, in the heading, after "PRIMARY", deleted
"PHYSICIAN" and added "CARE PRACTITIONER", in Paragraph (11) of Part 3 of the
form, after "the following", deleted "physician as my primary physician" and added "as
my primary care practitioner", after "name of", deleted "physician" and added "primary
care practitioner", after "If the", deleted "physician" and added "primary care
practitioner", after "act as my primary", deleted "physician" and added "care
practitioner", after "I designate the following", deleted "physician as my primary
physician" and added "as my primary care practitioner", and after "name of", deleted
"physician" and added "primary care practitioner"; and in Paragraph (13) of Part 3 of the
form, after the first occurrence of "supervising health-care", deleted "provider" and
added "practitioner", and after the second occurrence of "supervising health-care",
deleted "provider" and added "practitioner".

Temporary provisions. — Laws 2015, ch. 116, § 16 provided that by January 1, 2016,
every cabinet secretary, agency head and head of a political subdivision of the state
shall update rules requiring an examination by, a certificate from or a statement of a
licensed physician to also accept such examination, certificate or statement from an
advanced practice registered nurse, certified nurse-midwife or physician assistant
working within that person's scope of practice.

The 2000 amendment, effective May 17, 2000, in the fifth paragraph of the Explanation
section, added the third sentence; added Item 9 of Part 3 of the form and redesignated
the remaining sections accordingly.

The 1997 amendment, effective July 1, 1997, in the second paragraph of the form,
rewrote the last sentence which read "You do not have to sign any form"; in the
paragraph of the form explaining Part 2, substituted "life-sustaining treatment" for "the
provision, withholding or withdrawal of treatment to keep you alive" in the second
sentence; in paragraph (3) in Part 1 of the form, deleted "unless I mark the following
box" at the end of the first sentence and substituted "initial" for "mark" in the second
sentence; rewrote paragraphs (6), (7), and (8) in Part 2 of the form; substituted "either"
for "only" in the last sentence in paragraph (12) of Part 3 of the form; and made stylistic
changes.