Health Care Directive Form

Please have your attorney review the law in Health and Safety Code Chapter 166 for the details. Please type or print legibly MG-3598 Rev.

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State Definition 145C01 Subd.

Health care directive form. With my wishes as expressed in this document. It allows you to name a person agent to decide for you if you are unable to decide. You must be at least 18 years old to make a health care directive.

This health care directive will not be valid unless it is notarized or signed by two qualified witnesses who are present when you sign or acknowledge your signature. After the documents are filed a Registry Card containing a unique file number and password will be issued to the applicant. Print alternate agent ADDRESS and PHONE.

0504 Proxy 2 Name Address City Province Postal Code Telephone Part 3 Signature and Date You must sign and date this Health Care Directive. It is very important that you talk with this person about your health care wishes. What should I do with this form.

Health Care Directive and that you expect them to honor your wishes. Arizona Advance Health Care Directive This is a legal form that lets you have a voice in your health care. You may want to complete an Advance Directive for Health Care to memorialize these discussions and your preferences.

5a Health care directive means a written instrument that complies with section 145C03 and includes one or more health care instructions a health care power of attorney or both. The form serves as a guide for providing the appropriate information. No witness is required.

I direct that this document become part of my permanent medical records. The applicant can use the file number and password to access the directives online 24 hours a day 7 days a week 365 days per year. Statement of My Wishes Concerning My Future Health Care.

If you have any legal questions about your personal situation you should consult your own lawyer. By initialing here this Health Care Directive including Mental Health Care Power of Attorney may not be revoked if I am incapacitated. You can use it if you want or use others which are just as valid legally.

I am pleased to send you an advance directive form that you can use to plan for future health care decisions. 2 Share this form and your choices with your family friends and medical providers. If you have attached any additional pages to this form you must date and sign each of the additional pages at the same time you date and sign this health care directive.

What should I do with this form. A person can create a form that is different from the statutory form but the law was designed to create a form that would work well for most people. ADVANCE HEALTH CARE DIRECTIVE California Probate Code Section 4701 Explanation You have the right to give instructions about your own health care.

Print agent ADDRESS and PHONE. I make this HEALTH CARE DIRECTIVE Directive to exercise my right to determine the course of my health. You are not required to have an advance directive.

They provide a way for you to communicate your wishes to family friends and health care professionals and to avoid confusion later on. It will let your family friends and medical providers know how you want to be cared for if you cannot speak for yourself. Your provider can give you more information about that form.

It also allows you to name an agent if you want someone else to decide for you. ____ Give copies of the Advance Directive to your health care agent health care providers family close friends spiritual advisors and any other indi-viduals who might be involved in your care. The fee for each Advance Health Care Directive to be registered is 1000.

It will let your family friends and medical providers know how you want to be cared for if you cannot speak for yourself. If my agent is unwilling or unable to serve or continue to serve I hereby appoint. A DPOA for health care may take many forms.

If you decide to make an. A health care directive is a written document that informs other of your wishes about your health care. What is a Health Care Directive.

A directive may be made by anyone capable of making a health care decision and understanding the consequences of that decision. Signature Date If you are unable to sign yourself a substitute may sign. Persons you designate as your agent.

ADVANCE DIRECTIVE FOR HEALTH CARE Living Will and Health Care Proxy This form may be used in the State of Alabama to make your wishes known about what medical treatment or other care you would or would not want if you become too sick to speak for yourself. Or a durable power of attorney for health care. You do not need a lawyer to complete these forms.

This is the Health Care Directive of. Some states combine the two forms so you can record your treatment preferences and name your health care advocate in one document. Florida Advance Health Care Directive This is a legal form that lets you have a voice in your health care.

The attached form is. The form is optional. Advance Care Planning.

This instruction directive shall take effect in the event I become unable to make my own health care decisions as determined by the physician who has primary responsibility for my care and any necessary confirming determinations. When you download your states form. You also have the right to name someone else to make health care decisions for you.

Keep them informed about your current wishes. Utahs Advance Health Care Directive form is established in statute. The statutory advance health care directive form is as follows.

In this document you should give directions to the person you select as your spokesperson or health care agent or proxy about the full range of care you want. 2 Share this form and your choices with your family friends and medical providers. Advance directives are legal documents that allow you to convey your decisions about end-of-life care ahead of time.

This form lets you do either or both of these things. However any paper that is signed dated and provides the same information may be used. To make a health care directive but only wish to have an Agent make your decisions without the directive be sure that you have completed Part I on pages 1 2 mark an X through Part II on pages 2 3 and continue to Part III 1.

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