Printable Health Care Directive Form Advance Health Care Directive Forms 4700 4701 Chapter 2 added by Stats 1999 Ch 658 Sec 39 4701 The statutory advance health care directive form is as follows print your name sign your name 5 3 STATEMENT OF WITNESSES I declare under penalty of perjury under the laws of California 1 that the individual
Advance Directive Or Health Care Directive is a document that combines a medical power of attorney Medical Power of Attorney Or Health Care Proxy or Durable Health Care Form which allows a person to select someone else to make health care decisions on their behalf Print your name Witness Acknowledgment 21 Form 3 1 Advance Health Care Directive Page 4 of 8 03 19 CAFA HSPA ASSCA Part 2 Instructions for Health Care If you fill out this part of the form you may strike any wording you do not want End of Life Decisions I direct that my health care providers and others involved in my care provide withhold or withdraw
Printable Health Care Directive Form
Printable Health Care Directive Form
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Free Advance Directive Forms 50 States PDF WORD
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Health Care Directive Two witnesses or a notary public 23 06 5 05 Ohio Living Will Declaration Health Care Power of Attorney Two witnesses or a notary public 2133 02 A 1 1337 12 B C Oklahoma Advance Directive for Health Care Two witnesses 63 3101 4 Oregon Advance Directive for Health Care Two witnesses or a notary public California Advance Health Care Directive This is a legal form that lets you have a voice in your health care It will let your family friends and medical providers know how you want to be cared for if you cannot speak for yourself 2 Share this form and your choices with your family friends and medical providers What should I do with this
Complete your advance directive forms To make your care and treatment decisions official you can complete a living will Similarly once you decide on your health care proxy you can make it official by completing a durable power of attorney for health care Share your forms with your health care proxy doctors and loved ones CaringInfo a program of the National Hospice and Palliative Care Organization provides free resources to educate and empower patients and caregivers to make decisions about serious illness and end of life care and services CaringInfo s goal is that all people are making informed decisions about their care Learn more about CaringInfo
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2 Select or discharge health care providers and institutions 3 Approve or disapprove diagnostic tests surgical procedures and programs of medication 4 Direct the provision withholding or withdrawal of artificial nutrition and hydration and all other forms of health care including cardiopulmonary resuscitation 5 The future this is another type of advance directive and is often called a health care directive declaration or living will l No one can require me to sign an advance directive I have the right to choose to not do an advance directive at all l This information and these forms have been provided for my convenience I may use another form
Living wills and other advance directives are written legal instructions regarding your preferences for medical care if you are unable to make decisions for yourself Advance directives guide choices for doctors and caregivers if you re terminally ill seriously injured in a coma in the late stages of dementia or near the end of life HEALTH CARE DIRECTIVE U0285 U0285 UH0285 REV JAN 05 d If I have been diagnosed as pregnant and that diagnosis is known to my physician this directive shall have no force or effect during the course of my pregnancy e I understand the full import of this directive and I am emotionally and mentally capable to make the health care
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https://www.courts.ca.gov/documents/Advanced-HealthCare-Directive-Form_031620.pdf
Advance Health Care Directive Forms 4700 4701 Chapter 2 added by Stats 1999 Ch 658 Sec 39 4701 The statutory advance health care directive form is as follows print your name sign your name 5 3 STATEMENT OF WITNESSES I declare under penalty of perjury under the laws of California 1 that the individual
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Advance Directive Or Health Care Directive is a document that combines a medical power of attorney Medical Power of Attorney Or Health Care Proxy or Durable Health Care Form which allows a person to select someone else to make health care decisions on their behalf Print your name Witness Acknowledgment 21
Free Advance Directive Forms Living Will Medical POA PDF Word
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Printable Health Care Directive Form - For my health care as a personal representative under the Health Insurance Portability and Accountability Act of 1996 HIPAA and any similar state law Arrange for my health care and treatment in any state or location he or she thinks is appropriate Decide which health care providers and organizations provide my care and treatment
