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This is a state specific form specifying your desires if at any time you have an incurable injury, disease, or illness determined to be a terminal condition. The form is your request for the use of life prolonging procedures that would extend your life, including appropriate nutrition and hydration, the administration of medication, and the performance of all other medical procedures necessary to extend my life, to provide comfort care, or to alleviate pain.

How to fill out In Form 4?

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