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(your full name) of (your complete legal address) appoint (name of person you want to be your advocate) who lives at (that person s complete legal address) as my patient advocate.

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How to fill out the Bronson 9000354-E online

Filling out the Bronson 9000354-E, also known as the Durable Power of Attorney for Health Care, can be an important step in ensuring your medical preferences are honored. This guide will walk you through the process of completing the form step by step, providing clear instructions for each section to assist you.

Follow the steps to complete the Bronson 9000354-E accurately.

  1. Press the ‘Get Form’ button to access the Bronson 9000354-E document and open it in the editor.
  2. In the ‘Appointment of Patient Advocate’ section, enter your full name in the provided space, followed by your complete legal address. This identifies you as the individual granting power of attorney.
  3. Next, fill in the name of the person you wish to appoint as your patient advocate, along with their complete legal address. This person will be responsible for making medical decisions on your behalf.
  4. If applicable, appoint a second person as a backup patient advocate by entering their name and complete address. This ensures that there is always someone available to act in your best interest.
  5. Indicate any specific religious preferences regarding medical treatment, if applicable, in the designated area. You may expand on this using an attached sheet if needed.
  6. In the ‘Grants of Authority and Responsibility’ section, review the permissions you wish to grant your advocate. You can choose multiple options such as access to medical records and the ability to make treatment decisions.
  7. In the ‘Desires and Preferences for Treatment’ section, make choices regarding life support under various medical conditions. Carefully select your preferences as per the options provided.
  8. If you have additional wishes regarding treatment, particularly cultural or religious considerations, enter them in the space provided.
  9. Sign the form in the designated area and enter the date of your signature to validate your intent. Ensure your signature is executed in the presence of witnesses.
  10. Obtain signatures from two witnesses who meet the specified criteria. This step is crucial to fulfill legal requirements.
  11. Lastly, if your advocate accepts the role, they should fill in their details and sign where indicated, confirming their commitment to act as your patient advocate.
  12. Once completed, save the changes, and you may choose to download, print, or share the form as needed.

Start completing your Bronson 9000354-E online today to ensure your medical decisions are respected.

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