Georgia Advance Directive For Health Care (Page 10 of 14) in pdf

Georgia Advance Directive For Health Care Page 10

9. In Case of Pregnancy

PART TWO will be effective even if this section is left blank.

I understand that under Georgia law, PART TWO generally will have no force and effect if I am pregnant unless

the fetus is not viable and I indicate by initialing below that I want PART TWO to be carried out.

_________ I want PART TWO to be carried out if my fetus is not viable.

(Initials)

Part Three: Guardianship

10. Guardianship

PART THREE is optional. This advance directive for health care will be effective even if PART THREE is left

blank. If you wish to nominate a person to be your guardian in the event a court decides that a guardian

should be appointed, complete PART THREE. A court will appoint a guardian for you if the court finds that

you are not able to make significant responsible decisions for yourself regarding your personal support,

safety, or welfare. A court will appoint the person nominated by you if the court finds that the appointment

will serve your best interest and welfare. If you have selected a Health Care Agent in PART ONE, you may

(but are not required to) nominate the same person to be your guardian. If your Health Care Agent and

guardian are not the same person, your Health Care Agent will have priority over your guardian in making

your health care decisions, unless a court determines otherwise.

State your preference by initialing (A) or (B). Choose (A) only if you have also completed PART ONE.

A. _______ I nominate the person serving as my Health Care Agent under PART ONE to serve as my

guardian.

(Initials)

B. _______ I nominate the following person to serve as my guardian:

(Initials)

Name: _______________________________________________________________________

Address: ______________________________________________________________________

Telephone Numbers: _____________________________________________________________

(Home, Work, and Mobile)

Georgia Advance Directive For Health Care Page 10