Get Vermont Department Of Health Source Code: 53101301

Filling out the Vermont Department of Health Source Code: 53101301 is an important step in registering your advance directive. This guide aims to provide clear and concise instructions to help you navigate the process with ease.

Follow the steps to complete your Registration Agreement effectively.

1. Click the ‘Get Form’ button to obtain the form and open it in the editor.
2. Read the Registration Policy carefully before proceeding. Understand the terms and conditions pertaining to your advance directive.
3. Fill out the Registrant section. Provide your first, middle, and last name as well as your date of birth in the format MM/DD/YYYY. Ensure that your primary mailing address is clear and accurate.
4. Include your phone number in the designated field and indicate whether you wish to be contacted via email by selecting 'Yes' or 'No'. If 'Yes', enter your email address.
5. If you have a secondary mailing address, fill in that information as well. This section is optional and should be completed only if applicable.
6. Complete the Emergency Contacts section by providing the names, relationships, and contact information for both primary and secondary emergency contacts.
7. In the signature section, print your name clearly where indicated. Sign and date the form to affirm that the information provided is accurate and that you agree to the terms.
8. Attach a copy of your advance directive or, alternatively, a notice indicating the physical location of your advance directive.
9. Send the completed form and attached documents either by mailing them to the Vermont Advance Directive Registry or by faxing to the provided number.
10. After submission, retain a copy of the form and any correspondence for your records. You may then wait for a confirmation letter from the Registry.

Start filling out your documents online today for a smooth registration process.