Advance Directive

Advance Directive CALIFORNIA ADVANCE HEALTH CARE leading Including Power of Attorney for Health Cargon Imprint / MRN bankers bill: The schedule meets legal requirements for most Californians, but might non be appropriate in special circumstances. If you might stand special needs, consult an attorney. PART 1: APPOINTING AN AGENT TO affect HEALTH CARE DECISIONS NOTE: You should discuss your wishes in point in time with your designated agent(s) My name is:_____________________________________ Date of Birth:________________ My address is:_______________________________________________________________ In this document I appoint an agent. That agent will make wellness take decisions for me in the future, if and when I no longer put one over the mental capacity to make my own wellness carry on decisions. Optional: I want my agent to make my health portion out decisions now, even though I currently go through the mental capacity to make my own health care decisions. _______ (Do not initial here if you want to continue qualification your own health decisions for as long as you are able.) The following persons cannot be selected as your agent or renewal agent: Your primary physician An employee of the health care psychiatric hospital or residential care facility where you receive care (unless you are related to that person or you are co-workers).

base AGENT: operators Name: ___________________________________________________ Address:___________________________________________________________________ ____________________________________________________ (Phone rime indicate home, work, pager, and cellular phone) 1st ALTERNATE AGENT (If Agent is not willing, able, or reasonably available to serve.) Name of archetypal alternate agent: ____________________________________________________ Address:___________________________________________________________ ____________________________________________________ (Phone numbers indicate home, work, pager, and cellular phone) 2nd ALTERNATE AGENT (If Agent and 1st counterchange are... If you want to get a full essay, order it on our website: Ordercustompaper.com

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