Georgia Advanced Directive Page 3
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29Guide to Contents
INSTRUCTIONS......................................................................... 14 pages
1. Effect of 07/01/07 Changes................................................................................ 4
2. Definitions ............................................................................................................ 5
3. Certification of Declarant´s Condition ................................................................ 7
4. Use of Other Forms............................................................................................. 8
5. How the New form differs from the former Living Will and Durable Power of
Attorney for Health Care forms ............................................................................... 8
6. The New Form Described ................................................................................... 9
7. Executing an Advance Directive for Health Care .............................................. 9
8. Health Care Agent ............................................................................................. 10
Restrictions
............................................................................................................... 10
Duty
........................................................................................................................... 10
Responsibilities
........................................................................................................ 10
Prohibited Activities
................................................................................................. 11
9. Refusal to Comply with Directive ..................................................................... 12
10. Revoking a Directive ........................................................................................ 13
11. Completed form ................................................................................................ 13
12. For Additional Information .............................................................................. 14
ADVANCE DIRECTIVE – FORM ................................................ 15 pages
Description of Four Parts............................................................................... 1
Part One-Health Care Agent ............................................................... 3
ID of Agent........................................................................................... 3
Back-up Agent(s) ................................................................................ 4
General Powers of Agent .................................................................... 5
Guidance for Agent.............................................................................. 6
Agent’s Powers after Declarant’s Death ............................................ 7
Part Two-Treatment Preferences ...................................................... 8
Conditions when Effective .................................................................. 9
Treatment Preferences ....................................................................... 9
Part Three – Guardianship................................................................. 12
Part Four- Effectiveness/Signatures ................................................ 13
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Parent category: Medical