Hawaii Advance Health Care Directive Page 5
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8[ ] (b) I give the following organs, tissues, or parts only
[ ] (c) My gift is for the following purposes (strike any of the following you do not want)
(i) Transplant
(ii) Therapy
(iii) Research
(iv) Education
PART 4
PRIMARY PHYSICIAN
(OPTIONAL)
(11) I designate the following physician as my primary physician:
(name of physician)
(address)
(city)
(state) (zip code)
(phone)
OPTIONAL: If the physician I have designated above is not willing, able, or reasonably
available to act as my primary physician, I designate the following physician as my
primary physician:
(name of physician)
(address)
(city)
(state) (zip code)
(phone)
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