Georgia Advanced Directive Page 27
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29(Home, Work, and Mobile/Cell)
E-Mail Address: ____________________________________________________
PART FOUR: EFFECTIVENESS AND SIGNATURES
This advance directive for health care will become effective only if I am
unable or choose not to make or communicate my own health care
decisions.
Completing this form revokes and replaces any advance directive for health
care, durable power of attorney for health care, health care proxy, or living
will that I have completed before this date.
Unless I have initialed below and have provided alternative future dates or
events, this advance directive for health care will become effective at the
time I sign it and will remain effective until my death (and after my death to
the extent authorized in Section (5) of PART ONE).
__________ (Initials) This advance directive for health care will become
effective on or upon _______________________________ and will terminate on
or upon
(
)
Optional: Specify a date or event
_______________________________________________________________.
( Optional: Specify a date or event )
Page 13 of 15
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