
STATE OF WISCONSIN Ch. 154 Wis. Stats PO Box 2659 Madison, WI 537012659 608 2661568DEPARTMENT OF HEALTH SERVICES DIVISION OF PUBLIC HEALTH F44763 (Rev 07/2020) Page 1 of 2EMERGENCY CARE DO NOT RESUSCITATE.
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How to fill out the WI F-44763 online
This guide provides clear and comprehensive instructions on how to fill out the WI F-44763 form, also known as the Do Not Resuscitate Order. Whether you are a person seeking to document your wishes, a legal guardian, or a health care agent, this guide will help you navigate the process with ease.
Follow the steps to complete your WI F-44763 form effectively.
- Press the 'Get Form' button to obtain the WI F-44763 form, which will open it in your document editor.
- In the designated field, print the patient's name clearly. Ensure that all spelling is correct to avoid issues later.
- Fill in the patient's address, including street, city, state, and zip code in the appropriate spaces.
- Enter the patient's date of birth in the specified format. Make sure it aligns with other provided information.
- In the section for the signer, indicate who is signing the document by circling the appropriate title (patient, legal guardian, or health care agent).
- Have the signer provide their signature and include the date of signing in the designated space.
- The attending health care professional must print their name and telephone number in the provided fields. They will also need to sign and date the form.
- Ensure that all required signatures and dates are present, as these are essential for the order to be valid.
- After completing the form, users can choose to save the changes, download a copy, print the document, or share it with others if necessary.
Complete your WI F-44763 form online today and ensure your wishes are documented accurately.
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