Durable Power Of Attorney For Health Care Decisions Page 3
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12Part 3 of this form lets you express an intention to make an anatomical gift
following your death.
Part 4 of this form lets you make decisions in advance about certain types of
mental health treatment.
Part 5 of this form lets you designate a physician to have primary responsibility
for your health care.
After completing this form, sign and date the form at the end and have the form
witnessed by one of the two alternative methods listed below. Give a copy of the signed and
completed form to your physician, to any other health care providers you may have, to any
health care institution at which you are receiving care, and to any health care agents you have
named. You should talk to the person you have named as your agent to make sure
that the person understands your wishes and is willing to take the responsibility.
You have the right to revoke this advance health care directive or replace this
form at any time, except that you may not revoke this declaration when you are determined not
to be competent by a court, by two physicians, at least one of whom shall be a psychiatrist, or
by both a physician and a professional mental health clinician.
In this advance health care directive, "competent" means that you have the capacity
(1) to assimilate relevant facts and to appreciate and understand your situation
with regard to those facts; and
(2) to participate in treatment decisions by means of a rational thought process.
The form that follows is found in AS 13.52.300
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