Living Blank Form Sample Template
Living Blank Form Sample Template.
Living will updated mark of. living will end of life care instructions. general instructions use this form to make decisions now about your medical care if you are ever in a terminal condition, a persistent vegetative state or an irreversible coma. State of living will declaration county of i, full name, a resident of the state of, being of sound mind and having reached the age of eighteen years, do hereby make, publish and declare the following if the time comes when i can no longer take part in health care decisions for my.
Jan, health surrogate will of name introduction i am executing this catholic declaration on life and death while i am of sound mind. it is intended to clarify my wishes for treatment in situations that may arise in which i am incapacitated or unable living will continued i wish to designate the following person as my alternate surrogate, to carry out the provisions of this declaration should my surrogate be unwilling or unable to act on my behalf.
name address. Living will or health care instructions if the time comes when i am incapacitated to the point when i can no longer actively take part in decisions for my own life, and am unable to direct my physician as to my own medical care, i wish this statement to stand as a statement of my wishes.
Living will declaration r. s. sec. instructions per r. s. sec. , the secretary of states office has established a registry in which a person, or his attorney, if authorized by the person to do so, may register the original, multiple original, or a certified copy of the declaration.
Enrollment form. no expiration date. this living will declaration will have no expiration date. however, i may revoke it at any time. copies the same as original. any person may rely on a copy of this document. out of state application. i intend that this document be honored in any jurisdiction to the will.
to use this form. have two witnesses sign and date the bottom of your living will. i, name of, being of sound mind and at least eighteen years of age, direct that my life shall not be. artificially prolonged under the circumstances set forth below and hereby declare that.
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