Georgia Advance Directive For Health Care (Page 5 of 14) in pdf

This advance directive for health care has four parts:

Part I: Health Care Agent.

This part allows you to choose someone to make health care decisions for you when you cannot (or do not

want to) make health care decisions for yourself. The person you choose is called a Health Care Agent. You

may also have your Health Care Agent make decisions for you after your death with respect to an autopsy,

organ donation, body donation, and final disposition of your body. You should talk to your Health Care Agent

about this important role.

Part II: Treatment Preferences.

This part allows you to state your treatment preferences if you have a terminal condition or if you are in a state

of permanent unconsciousness. PART TWO will become effective only if you are unable to communicate your

treatment preferences. Reasonable and appropriate efforts will be made to communicate with you about your

treatment preferences before PART TWO becomes effective. You should talk to your family and others close to

you about your treatment preferences.

Part Three: Guardianship

This part allows you to nominate a person to be your guardian should one ever be needed.

Part Four: Effectiveness and Signatures.

This part requires your signature and the signatures of two witnesses. You must complete PART FOUR if you

have filled out any other part of this form.

You may fill out any or all of the first three parts listed above. You must fill out PART FOUR of this form in

order for this form to be effective.

You should give a copy of this completed form to people who might need it, such as your Health Care Agent,

your family, and your physician. Keep a copy of this completed form at home in a place where it can easily

be found if it is needed. Review this completed form periodically to make sure it still reflects your preferences.

If your preferences change, complete a new Georgia Advance Directive for Health Care.

Using this form of advance directive for health care is completely optional. Other forms of advance directives

for health care may be used in Georgia.

You may revoke this completed form at any time. This completed form will replace any advance

directive for health care, durable power of attorney for health care, health care proxy, or living

will that you have completed before completing this form.

Georgia Advance Directive For Health Care Page 5