Advance Directive For Health Care Page 2
Download a blank fillable Advance Directive For Health Care 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 Directive For Health Care 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(a)
if I have an incurable and irreversible condition that even with the
administration of life-sustaining treatment will cause my death within six (6)
months, or
Initial one box only
Q
Q
YES
NO
(b)
if I am in an irreversible condition in which thought and awareness of self
and environment are absent.
Initial one box only
Q
Q
NO
YES
(3)
I direct that (add other medical directives, if any) ____________________
Initial one box only
Q
Q
YES
NO
II.
MY APPOINTMENT OF MY HEALTH CARE PROXY
If my attending physician and another physician determine that I am no longer able to make
decisions regarding my medical treatment, I direct my attending physician and other health
care providers pursuant to the Oklahoma Rights of the Terminally Ill or Persistently
Unconscious Act to follow the instructions of _______________, whom I appoint as my
health care proxy. If my health care proxy is unable or unwilling to serve, I appoint
____________________, as my alternate health care proxy with the same authority. My
health care proxy is authorized to make whatever medical treatment decisions I could make
if I were able, except that decisions regarding life-sustaining treatment can be made by my
health care proxy or alternate health care proxy only as I have indicated in the foregoing
sections.
Initial one box only
Q
Q
YES
NO
III.
ANATOMICAL GIFTS
I direct that at the time of my death my entire body or designated body organs or body parts
be donated for purposes of transplantation, therapy, advancement of medical or dental
science or research or education pursuant to the provisions of the Uniform Anatomical Gift
Act. Death means either irreversible cessation of circulatory and respiratory functions or
irreversible cessation of all functions of the entire brain, including the brain stem. If I initial
the “yes” box below, I specifically donate:
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal