Get Bronson 9000354-e 2015-2025

The Bronson 9000354-E is a crucial document for establishing a Durable Power of Attorney for Healthcare, allowing users to designate a Patient Advocate. This guide provides clear, step-by-step instructions to help users navigate the online form effectively.

Follow the steps to complete the Bronson 9000354-E form online.

1. Press the ‘Get Form’ button to access the Bronson 9000354-E and open it in your selected editor.
2. In the introduction section, provide your name, date of birth, and contact information including your day and evening phone numbers. Ensure to include the last four digits of your Social Security number and your address with city, state, and zip code. Clearly indicate where you would like to receive hospital care, if possible.
3. Move to the section titled 'Advance Directive: My Patient Advocate.' Here, appoint your primary Patient Advocate by entering their name, relationship (if any), and their contact information. Make sure to provide both day and evening phone numbers along with their address.
4. Designate your first alternate Patient Advocate by filling in the required details in the respective section. This person will step in should your primary advocate become unavailable.
5. Provide information for the second alternate Patient Advocate, following the same format as for the first alternate. This additional measure ensures that your wishes will be respected, regardless of circumstances.
6. Sign the signature page where you indicate your understanding of and consent to the terms outlined in the document. Ensure that your signature is accompanied by the date of signing and your address.
7. Engage two witnesses to sign the document, ensuring that they meet the specified eligibility requirements listed in the form. Record their names, signatures, and addresses.
8. Should you wish to accept the role of Patient Advocate, print your name and date of birth in the dedicated acceptance section. The designated Patient Advocate should then read and sign the acceptance statement.
9. Complete the optional 'Treatment Preferences' section by indicating your wishes regarding life-sustaining treatments and CPR, as applicable. Record your initials next to your chosen preferences.
10. Finally, review the completed form for accuracy. Save your changes, then download, print, or share your finalized document as required.

Complete your Bronson 9000354-E form online today for peace of mind regarding your future healthcare decisions.