Georgia Advanced Directive Page 28
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29[You must sign and date or acknowledge signing and dating this form in the
presence of two witnesses.]
Both witnesses must be of sound mind and must be at least 18 years of
age, but the witnesses do not have to be together or present with you when
you sign this form.
A witness:
Cannot be a person who was selected to be your health care agent or
•
back-up health care agent in PART ONE;
Cannot be a person who will knowingly inherit anything from you or
•
otherwise knowingly gain a financial benefit from your death; or
Cannot be a person who is directly involved in your health care.
•
Only one of the witnesses may be an employee, agent, or medical staff
member of the hospital, skilled nursing facility, hospice, or other health care
facility in which you are receiving health care (but this witness cannot be
directly involved in your health care).]
By signing below, I state that I am emotionally and mentally capable of
making this advance directive for health care and that I understand its
purpose and effect.
_________________________________________ ________________
(Signature of Declarant)
(Date)
Page 14 of 15
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