Advance Health Care Directive Template Page 6
Download a blank fillable Advance Health Care Directive Template in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Advance Health Care Directive Template with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6request, and in the presence of each other, have hereunto subscribed our names as witnesses,
and state:
A.
The Declarant is mentally competent.
B.
That neither of us is prohibited by §2503 of Title 16 of the Delaware Code from
being a witness. Neither of us:
1.
Is related to the declarant by blood, marriage or adoption;
2.
Is entitled to any portion of the estate of the declarant under any will of
the declarant or codicil thereto then existing nor, at the time of the
executing of the advance health care directive, is so entitled by operation
of law then existing;
3.
Has, at the time of the execution of the advance health care directive, a
present or inchoate claim against any portion of the estate of the
declarant;
4.
Has a direct financial responsibility for the declarant's medical care;
5.
Has a controlling interest in or is an operator or an employee of a
health care institution in which the declarant is a patient or resident; or
6.
Is under eighteen years of age.
C. That if the declarant is a resident of a sanitarium, rest home, nursing home,
boarding home or related institution, one of the witnesses, __________________
___________________, is at the time of the execution of the advance health care
directive, a patient advocate or ombudsman designated by the Division of Services
for Aging and Adults with Physical Disabilities or the Public Guardian.
Witness
Witness
__________________________________
__________________________________
(print name)
(print name)
__________________________________
__________________________________
(address)
(address)
__________________________________
__________________________________
(city, state, zip code)
(city, state, zip code)
__________________________________
__________________________________
(signature of witness)
(date)
(signature of witness)
(date)
(Optional)
Sworn and subscribed to me this _____ day of _________________________.
My term expires: _______________________
__________________________________
(Notary)
Advance Health Care Directive of ________________________________________________________
Page 6
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical