{"data":{"id":"us-nh/rsa-464-d-16","jurisdiction":"us-nh","citation":"RSA 464-D:16","heading":"Form of Supported Decision-making Agreement.","body":"A supported decision-making agreement may be in any form not inconsistent with the following form and the other requirements of this chapter. Use of the following form is presumed to meet statutory provisions.\nSUPPORTED DECISION-MAKING AGREEMENT\nThis agreement must be communicated to all parties to the agreement in the presence of either a notary or 2 witnesses. The form of communication must be appropriate to the needs and preferences of the person with a disability. Reading the agreement out loud or using a sign language interpreter may be necessary.\nMy name is ______________________________ .\nI want to have people I trust help me make decisions. The people who will help me are called supporters. My supporters are not allowed to make the decisions for me. I will make my own choices, with their support. I am called the principal.\nThis agreement can be changed at any time. I can change it by crossing out words and writing my initials next to the change. I can also end this agreement at any time by._\nSignature of Principal\nI am making this supportive decision-making agreement because I want people to help me make choices. I know that I do not have to make this agreement. I know that I can change this agreement at any time.\nMy printed name: _____________________________________________ .\nMy address: _____________________________________________\nMy phone number: _____________________________________________ .\nMy email address: _____________________________________________ .\nToday's date: _____________________________________________\nSupporters\nSupporter #1\nI agree that ______________________________ (name) will be my supporter. Their contact information is:.\nAddress: _____________________________________________ .\nPhone Number: _____________________________________________ .\nE-mail Address: _____________________________________________\nMy supporter may help me with making everyday life decisions relating to the following:.\nObtaining food, clothing, and shelter: Yes __________ No __________\nTaking care of my physical health: Yes __________ No __________\nTaking care of my mental health: Yes __________ No __________\nManaging my financial affairs: Yes __________ No __________\nApplying for and managing public benefits: Yes __________ No __________\nMy education: Yes __________ No __________\nApplying for and managing employment: Yes __________ No __________\nThe following are other decisions that I have specifically identified that I would like assistance with:\n__________________________________________________ .\nSupporter #2.\nI do not have to have more than one supporter. I choose to have ______________________________ (name) also be my supporter. Their contact information is:.\nAddress: _____________________________________________ .\nPhone Number: _____________________________________________ .\nE-mail Address: _____________________________________________\nis my supporter. My supporter may help me with making everyday life decisions relating to the following:\nObtaining food, clothing, and shelter: Yes ____ No ____\nTaking care of my physical health: Yes ____ No ____\nTaking care of my mental health: Yes ____ No ____\nManaging my financial affairs: Yes ____ No ____\nApplying for and managing public benefits: Yes ____ No ____\nMy education: Yes ____ No ____\nApplying for and managing employment: Yes ____ No ____\nThe following are other decisions that I have specifically identified that I would like assistance with:\n__________________________________________________ .\nTo help me with my decisions, my supporter(s) may do the following things (check all that apply):\n( ) Help me access, collect, or obtain information that is relevant to a decision, including medical, psychological, educational, or treatment records;.\n( ) Help me gather and complete appropriate authorizations and releases;.\n( ) Help me understand my options so I can make an informed decision; and.\n( ) Help me communicate my decision to appropriate persons.\nMonitor for Financial Matters\nIf I want someone to help me make choices about money, I may also choose someone to make sure my supporters are being honest and using good judgment in helping me with my money. This person is called a monitor. A monitor cannot also be a supporter.\nI agree that ______________________________ (name) will be my monitor. Their contact information is:\nAddress: __________________________________________________\nPhone Number: __________________________________________________ .\nE-mail Address: __________________________________________________\nEffective Date of Supported decision-making Agreement.\nThis supported decision-making agreement is effective immediately and will continue until ____________________ (insert date) or until the agreement is terminated by my supporter or me or by operation of law.\nThe date of this agreement is __________________________________________________ .\nConsent of Supporter(s)\nSupporter #1: I, ______________________________ (name of supporter), consent to act as a supporter under this agreement, and acknowledge my responsibilities under RSA 464-D.\n_ ._ (Signature of supporter) (Printed name of supporter). My relationship to the principal is: ____________________ .\nSupporter #2: I, _________________________ (name of supporter), consent to act as a supporter under this agreement, and acknowledge my responsibilities under RSA 464-D.\n_ ._ (Signature of supporter) (Printed name of supporter). My relationship to the principal is: ____________________ .\nAdditional supporters may be added below as necessary.\nConsent of Monitor\nI, ______________________________ (name of monitor), consent to act as a monitor under this agreement, and acknowledge my responsibilities under RSA 464-D.\n_ ._ (Signature of monitor) (Printed name of monitor). My relationship to the principal is: _________________________ .\nConsent of the Principal\nWait until a notary or 2 witnesses are there to watch you sign.\n_ ._ (My signature) (My printed name). Witnesses or Notary.\n_ ._ (Witness signature) (Printed name of witness ). _ ._ (Witness signature) (Printed name of witness )","path":["Title XLIV: GUARDIANS AND CONSERVATORS","Chapter 464-D: SUPPORTED DECISION-MAKING"],"source_url":"https://gc.nh.gov/rsa/html/XLIV/464-D/464-D-16.htm","current_through":"2025 regular legislative session, or December 2025","vintage":"","retrieved_at":"2026-09-05T16:29:49Z","sha256":"816aa11e594e64fb84f6867fd2cf64b7ba1d8a806b90cbbe578dc5ecd0401a26","source_id":"us-nh","stale":false,"prev":"us-nh/rsa-464-d-15","next":"us-nh/rsa-465-1"},"notice":"GroundRules: Original legal text. Not legal advice."}