California Advance Health Care Directive
California Advance Health Care Directive his for lets yo have a say aot ho yo ant to e cared for if yo cannot sea for yorself Your Name 1 TM Developed by for your care www.prepareforyourcare.org You can fill out Part 1, Part 2, or both. Fill out only the parts you want. Always sign the form in Part 3.
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South Carolina Advance Health Care Directive
prepareforyourcare.orgA medical decision maker is a person who can make health care decisions for you if you are not able to make them yourself. This person will be your advocate. They are also called a health care agent, proxy, or surrogate. Make your own health care choices, Page 7 This form lets you choose the kind of health care you want.
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Pennsylvania Advance Health Care Directive
prepareforyourcare.orgA medical decision maker is a person who can make health care decisions for you if you are not able to make them yourself. This person will be your advocate. They are also called a health care agent, proxy, or surrogate. Make your own health care choices, Page 7 This form lets you choose the kind of health care you want.
Health, Pennsylvania, Care, Directive, Health care, Advance, Proxy, Pennsylvania advance health care directive
Colorado Advance Health Care Directive
prepareforyourcare.orgColorado 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. If you are not able, your medical decision maker can choose
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Pennsylvania Advance Health Care Directive
prepareforyourcare.orgPennsylvania 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. If you are not able, your medical decision maker can choose
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Maryland Advance Health Care Directive - Prepare for your …
prepareforyourcare.orgMaryland Advance Health Care Directive his r lets y have a say at h y ant t e cared r i y cannt sea r yrsel Your Name 1 M Developed by for your care www.prepareforyourcare.org You can fill out Part 1, Part 2, or both. Fill out only the parts you want. Always sign the form in Part 3. 2 witnesses need to sign on Page 14. This form has 3 parts:
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Arizona Advance Health Care Directive
prepareforyourcare.orgPart 2: Make your own health care choices Arizona Advance Health Care Directive Your Name 9 AT THE END OF LIFE Some people are willing to live through a lot for a chance of living longer. Other people know that certain things would be very hard on their quality of life. • Those things may make them want to focus on comfort rather than trying ...
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Indiana Advance Health Care Directive
prepareforyourcare.orgMental health treatment Start or stop life support or medical treatments, such as: Part 1: Choose your health care representatives Here are more decisions your health care representatives can make: • agree to, refuse, or withdraw any life support or medical treatment if you are not able to speak for yourself
Michigan Advance Health Care Directive - Prepare for your …
prepareforyourcare.orgYour Name 1 M Developed by for your care www.prepareforyourcare.org You can fill out Part 1, Part 2, or both. Fill out only the parts you want. Always sign the form in Part 3. 2 witnesses need to sign on Page 14. If you choose a medical decision maker, they must also sign on Page 15. This form has 3 parts: Choose a medical decision maker, Page 3
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Florida Advance Health Care Directive
prepareforyourcare.orgTo make your own health care choices, go to Part 2 on Page 7. If you are done, you must sign this form on Page 13. Please share your wishes with your family, friends, and medical providers. If you want, you can write why you chose your #1 and #2 decision makers. Write down anyone you would NOT want to help make medical decisions for you.
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FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE
shc.uci.eduadvance directive in my presence, (3) that the individual appears to be of sound mind and under no duress, fraud, or undue influence, (4) that I am not a person appointed as agent by this advance directive, and (5) that I am not the individual’s health care provider, an employee of the individual’s health care provider,
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Sample of Advance Care Directive Form
advancecaredirectives.sa.gov.auThe Advance Care Directive Information Statement was given through me to _____ (name of person giving ... Form approved by the Minister for Health pursuant to the Advance Care Directives Act 2013 (SA) Part 5 Do not complete this Part unless an Interpreter was used. If …
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California Advance Health Care Directive
med.stanford.eduFeb 27, 2015 · California Advance Health Care Directive This form lets you have a say about how you want to be treated if you get very sick. This form has 3 parts. It lets you: Part 1: Choose a medical decision maker. A medical decision maker is a person who can make
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LEVEL OF CARE GUIDELINES: MENTAL HEALTH CONDITIONS
www.providerexpress.compsychoeducation, motivational interviewing, recovery and resiliency planning, advance directive planning, and facilitating involvement with self-help and wraparound services. The provider informs the member of safe and effective treatment alternatives, as well as the potential risks ... Level of Care Guidelines: Mental Health Conditions ...
Health, Guidelines, Conditions, Care, Directive, Mental, Advance, Advance directive, Care guidelines, Mental health conditions
ADVANCE HEALTH CARE DIRECTIVE
dhss.alaska.govhealth clinician. In this advance health care directive, "competent" means that you have the capacity (1) to assimilate relevant facts and to appreciate and understand your situation with regard to those facts; and (2) to participate in treatment decisions by means of a rational thought process. Advance Health Care Directive page 3 of 13
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Advance Directive for Health Care - Oklahoma Department …
www.okdhs.orgproviders pursuant to the Oklahoma Advance Directive Act to follow the instructions of: _____, whom I appoint as my health care proxy. If my health care proxy is or becomes unable or unwilling to serve, I appoint: _____ as my alternate health care proxy with the same authority.
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