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  • Dominion Form Smcc 2017

Get Dominion Form Smcc 2017-2025

Umber: Water Account Number: Contact Telephone Number: City: I State: I Zip Code: Alternate Telephone Number: I certify that the information above is accurate and the patient is the customer or a family member of the customer residing at this residence. Customer Signature: Date: To Be Completed by the Patient/Legal Guardian/Power of Attorney: Patient Name: Patient Relationship to Customer: Contact Telephone Number: Alternate Telephone Number: I hereby authorize my physician to release the.

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This section of the advance directive form is called a Durable Power of Attorney for Health Care. It lets you appoint a specific person to make health care decisions for you in case you can't make decisions for yourself anymore. This person will be called your Health Care Agent.

Use VA Form 10-0137 to give specific people permission to make health care decisions for you, and to let VA health care providers know your wishes for medical, mental health, long-term, and other types of care.

An Advance Directive is the best way to ensure that your future medical care reflects your wishes. The VA Advance Directive includes sections that allow you to identify the person who would make decisions for you (also called a Health Care Agent) and to specify your treatment preferences.

Use VA Form 10-0137 to give specific people permission to make health care decisions for you, and to let VA health care providers know your wishes for medical, mental health, long-term, and other types of care.

A VA Form 10-0137 is used by the Veterans Health Administration (VHA), United States Department of Veterans Affairs. This form is known as a VA Advance Directive: Living Will and Durable Power of Attorney for Health Care.

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© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232
Form Packages
Adoption
Bankruptcy
Contractors
Divorce
Home Sales
Employment
Identity Theft
Incorporation
Landlord Tenant
Living Trust
Name Change
Personal Planning
Small Business
Wills & Estates
Packages A-Z
Form Categories
Affidavits
Bankruptcy
Bill of Sale
Corporate - LLC
Divorce
Employment
Identity Theft
Internet Technology
Landlord Tenant
Living Wills
Name Change
Power of Attorney
Real Estate
Small Estates
Wills
All Forms
Forms A-Z
Form Library
Customer Service
Terms of Service
DMCA Policy
About Us
Blog
Affiliates
Contact Us
Privacy Notice
Delete My Account
Site Map
All Forms
Search all Forms
Industries
Forms in Spanish
Localized Forms
Legal Guides
Real Estate Handbook
All Guides
Prepared for You
Notarize
Incorporation services
Our Customers
For Consumers
For Small Business
For Attorneys
Our Sites
US Legal Forms
USLegal
FormsPass
pdfFiller
signNow
airSlate workflows
DocHub
Instapage
Social Media
Call us now toll free:
1-877-389-0141
As seen in:
  • USA Today logo picture
  • CBC News logo picture
  • LA Times logo picture
  • The Washington Post logo picture
  • AP logo picture
  • Forbes logo picture
© Copyright 1997-2025
airSlate Legal Forms, Inc.
3720 Flowood Dr, Flowood, Mississippi 39232