Get Patient Protest Attachment - Sentara.com

Filling out the Patient Protest Attachment is an important step in ensuring that your healthcare wishes are clearly communicated and respected. This guide will provide you with a clear, step-by-step process to complete the form accurately and effectively, all while guiding you through each component.

Follow the steps to fill out the Patient Protest Attachment successfully.

1. Press the ‘Get Form’ button to obtain the form and open it in the appropriate online editor.
2. Begin by filling in your full name in the designated field marked 'Name.' Ensure that your name matches official documents for consistency.
3. Provide your Social Security Number in the format requested, ensuring that you include all three sections separated by hyphens.
4. Enter your complete address, including street name and number, city, state, and zip code. Double-check for accuracy to avoid any delays.
5. Input your phone number in the specified format to allow for easy communication.
6. Complete the section for the Sentara Healthcare Advance Directive, paying attention to the USLWR Source Code if needed.
7. In the section regarding your agent’s authority, clearly outline any conditions or exceptions to your healthcare agent's powers regarding treatment over your protest.
8. Ensure that a physician’s signature is obtained, as well as their printed name and office phone, indicating that you are capable of making informed decisions.
9. Sign and date the form in the space provided to indicate your agreement.
10. Two witness signatures are required; make sure both witnesses sign and provide necessary details, confirming your choice.
11. Once all sections are completed, you may save changes, download, print, or share the form as needed.

Complete your Patient Protest Attachment online to ensure your healthcare wishes are honored.