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Pennsylvania Advance Health Care Directive
Your Name 7 Part 2 Make your own health care choices Fill out only the questions you want. How do you prefer to make medical decisions? What is most important in your life? Check as many as you want. Your family or friends Your pets Hobbies, such as gardening, hiking, and cooking Your hobbies Working or volunteering
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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:
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
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.
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
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.
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
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.
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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