Georgia Advanced Directives For Health Care Form printable pdf download

GEORGIA ADVA}ICE DIRECTTVE FOR HEALTFI CARE

Date of Birth'

By:

(Print Name)

This advance directivefor health care hasfourparts:

PART ONE

PART TWO

PART THREE

PARTFOUR

(Month/DaylYear)

HEALTH CARE AGENT. This part allows youto choose someone to make

health care deeisions for you when you cannot (or do not want to) make

health care decisions for yourself, Tir" p"rron 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, bidy

donation, andfinal disposition ofyour body. you should talkto your heatih

care agent about this important role.

TREATMENT

PREFERENCES.

This part allows you to state your

treatment preferences ifyou have a terminal condition or ifyou are in a state

ofpermanentunconsciousness. PART TWo will become effective only ifyou

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 yourfamily and others close to you about your treatment preferences.

GUARDIANSHIP.

This part allows you to nominate a person to be your

guardian should one ever be needed.

EFFECTTVENESS AND SIGNATURES. This part requires your signature

and the signatures of two witnesses. You must complete PART FOUR rfyou

havefilled out any other part of thisform.

You mayJill aut any or all of thefirst three parts listed above. You mustfill out PART FOUR of this

form in orderfor thisform to be efective.

You should give a copy of this completedform to people who might need it, such as your health care

agent, your family, and your physician. Keep a copy of this completed

for*

at home in a place

where it can easily befound if it is needed. Review this completedformperiodically

to mak) sure

it still reflects your preferences. Ifyour preferences change, complete a nety advanie directivefor

healtl, care.

Using thisform of advance directivefor health care is completely optional. Atherforms of advance

directivesfor heqlth csre may be used in Georgia

P agelof 9pai;es .

Georgia Advanced Directives For Health Care Form

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