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Alaska Advance Health Care Directive Form 2

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Alaska Advance Health Care Directive Form 2 Page 2
(c) approve or disapprove proposed diagnostic tests, surgical
procedures, programs of medication, and do not resuscitate orders; and
(d) direct the provision, withholding, or withdrawal of artificial
nutrition and hydration and all other forms of health care; and
(e) make an anatomical gift following your death.
Part 2 of this form lets you give specific instructions for your
end-of-life health care. Choices are provided for you to express your
wishes regarding the provision, withholding, or withdrawal of
treatment to keep you alive, including the provision of artificial
nutrition and hydration, as well as the provision of pain relief
medication. Space is provided for you to add to the choices you have
made or for you to write out any additional wishes.
Part 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
Alaska Advance Health Care Directive Form 2
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