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Arizona Advance Health Care Directive
Part 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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California Advance Health Care Directive
prepareforyourcare.orgCalifornia 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.
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.
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.
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
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
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:
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
California Advance Health Care Directive
prepareforyourcare.orgThis 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.
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
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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Advanced Health Care Directive Form - California
oag.ca.govAdvance 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: ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4701) Explanation You have the right to give instructions about your own health care. You also have the right ...
FORM 3-1 ADVANCE HEALTH CARE DIRECTIVE
shc.uci.eduADVANCE HEALTH CARE DIRECTIVE (03/17) California Hospital Association Page 1 of 8 INSTRUCTIONS Part 1 of this form 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.
Advance Directive - CALIORNIA
www.instituteforhumancaring.orgAdvance Directive - CALIFORNIA This advance directive and designation of a health care representative is in compliance with application sections of Chapters 1 and 2 of the California Uniform Health Care Decisions Act (California Probate Code Sections 4670 through 4701). Step 4: Sign the form, continued. Witnesses' signatures
Pennsylvania Advance Health Care Directive
prepareforyourcare.orgPart 2: Make your own health care choices Pennsylvania 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.
Advance Healthcare Directive - UCLA Health: Center for ...
www.uclahealth.orgAfter you have completed your advance directive, discuss it with your healthcare team. They will place the document in CareConnect, UCLA’s electronic health record. At UCLA Health, we want to be a partner in your healthcare decisions. We strive to provide the best medical care to achieve each patient’s health objectives.
Advance Health Care Directive - Kaiser Permanente
healthy.kaiserpermanente.orgThis Advance Health Care Directive will replace any Advance Health Care Directive you have completed in the past, to the extent that they differ. If you want to cancel or change your named agent, complete a new document or inform your health care provider in person. Full name: Medical Record number: Date of birth: Mailing address: