Advance directive you do not have to fill out and sign this form part a: important information about this advance directive this is an important legal document. it can control critical decisions about your health care. before signing, consider...
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Rush university medical center patient name: date of birth: medical record #: place patient label health care surrogate act physician certification it has been determined that patient has one or more of the following conditions: terminal condition...
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Texas advance directive planning for important health care decisions caring connections 1731 king st., suite 100, alexandria, va 22314 .caringinfo.org 800/658-8898 caring connections, a program of the national hospice and palliative care...
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Utah advance health care directive (pursuant to utah code section 75-2a-117) part i: allows you to name another person to make health care decisions for you when you cannot make decisions or speak for yourself. part ii: allows you to record your...
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New jersey living will and health care surrogate declaration day of on this ,20 , i, (print name) of (mailing address) (city and state) (zip) social security number (phone) willfully and voluntarily make known my desire that my dying not be...
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