Wyoming Advance Health Care Directive Form Page 3
Download a blank fillable Wyoming Advance Health Care Directive Form in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Wyoming Advance Health Care Directive Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3
4
5
6
7Print your full name: ______________________________________________________________________
Today’s date: _________________________ Initial that you have completed the page: ______
(3) When agent’s authority becomes effective: My agent's authority to make
health care decisions for me takes effect at the following time (check and initial only
one (1) option):
Check
Initial
___
If I check the box and initial, my agent's authority to make health care
decisions for me becomes effective only when my primary physician or, in his/her
absence, my treating primary health care provider determines that I lack the capacity to
make my own health care decisions;
OR
___
If I check the box and initial, my agent's authority to make health care
decisions for me becomes effective only when my primary physician (and not when any
then treating health care provider of mine) determines that I lack the capacity to make
my own health care decisions;
OR
___
If I check the box and initial, my agent's authority to make health care
decisions for me becomes effective as necessary immediately upon my execution of
this Advance Health Care Directive Form.
(4) Agent’s obligation: My agent shall make health care decisions for me in
accordance with this power of attorney for health care using any instructions I give in
Part 2 of this form, and my other wishes to the extent known to my agent. To the extent
that my wishes are unknown, my agent shall make health-care decisions for me in
accordance with what my agent determines to be in my best interest. In determining my
best interest, my agent shall consider my personal values to the extent known to my
agent.
3
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Medical