Georgia Advance Directive For Health Care (Page 3 of 6) in pdf

Georgia Advance Directive For Health Care Page 3

5. Powers of Health Care Agent After Death

(A) AUTOPSY

My health care agent will have the power to authorize an autopsy of my body unless I have limited my health care

agent´s power by initialing below.

_________ (Initials) My health care agent will not have the power to authorize an autopsy of my body (unless an

autopsy is required by law).

(B) ORGAN DONATION AND DONATION OF BODY

My health care agent will have the power to make a disposition of any part or all of my body for medical purposes

pursuant to the Georgia Anatomical Gift Act, unless I have limited my health care agent´s power by initialing below.

Initial each statement that you want to apply.

_________ (Initials) My health care agent will not have the power to make a disposition of my body for use in a

medical study program.

_________ (Initials) My health care agent will not have the power to donate any of my organs.

My health care agent will have the power to make decisions about the final disposition of my body unless I have

initialed below.

_________ (Initials) I want the following person to make decisions about the final disposition of my body:

Name:

Address:

Telephone Numbers:

(Home, Work, and Mobile)

I wish for my body to be:

_________ (Initials) Buried

_________ (Initials) Cremated

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Georgia Advance Directive For Health Care Page 3