Durable Power Of Attorney For Health Care Choices & Health Care Choices Directive Page 4

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DURABLE POWER OF ATTORNEy FOR HEALTH CARE & HEALTH CARE DIRECTIVE
I also give the following directions regarding my health care:
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Describe what you consider an acceptable quality of life. For example, being able
Optional:
to recognize my loved ones, make decisions, communicate or feed yourself.
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
__________________________________________________________________________
Attach extra pages if necessary. Sign and date the attached pages.
Make sure to talk about this directive and your wishes with your agent, your doctors,
family, friends and clergy. Give each of them a copy of the directive. Bring a copy with
you when you go to a hospital or other health care facility. Keep the original with your
important papers.
1
LIFE CHOICES
ago.mo.gov

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