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HEALTH CARE PROXY AND ORGAN DONOR FORM 1. I, hereby appoint (name, home address and telephone number) as my health care agent to make any and all health care decisions for me, except to the extent
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How to fill out form health care proxy
How to fill out form health care proxy
01
Start by obtaining a copy of the health care proxy form. You can usually get this form from your healthcare provider or download it from their website.
02
Read the instructions and familiarize yourself with the purpose and contents of the form.
03
Begin by providing your personal information, including your full name, address, date of birth, and contact details.
04
Identify the person you want to appoint as your healthcare agent. Provide their full name, address, phone number, and relationship to you.
05
Make sure to discuss your wishes, values, and preferences regarding medical treatment with your healthcare agent beforehand.
06
Specify any specific medical treatments or procedures you wish to allow or refuse, if applicable.
07
Sign and date the form in the presence of two witnesses. The witnesses must also sign and date the form.
08
It is recommended to have the form notarized to ensure its legal validity.
09
Make copies of the completed form and distribute them to your healthcare agent, primary care physician, and any other relevant healthcare providers.
10
Review and update your health care proxy form periodically, especially if there are any changes in your personal circumstances or preferences.
Who needs form health care proxy?
01
Anyone who is above the age of 18 and wants to ensure their medical treatment decisions are made according to their own wishes should consider filling out a health care proxy form.
02
Patients with serious health conditions or those who anticipate undergoing medical procedures may find it particularly important to have a health care proxy in place.
03
It is also valuable for individuals who want to appoint a trusted person to advocate for their best interests in medical matters if they become unable to communicate their preferences.
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