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Get MI WP 11479 2010-2021

_______________________________________________ (Patient Advocate) residing at ______________________________________________________________________, (Patient Advocate Address) as my attorney in fact (herein called patient advocate) with the following power to be exercised in my name and for my benefit, including, but not limited to, making decisions regarding my care, custody or medical treatment. This power of attorney has effect only if I become unable to participate in treatment decisions.

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