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If I Leave This Part Blank, It Is Not A Refusal To Make A Donation.

Part 1 of this form is a power of attorney for health care. One (1) witness or a notary public. Below is a free blank template you can download in pdf or word format, print out, and fill out independently. Part 1 lets you name another individual as agent to make health care.

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The Principal May Articulate Which Types Of Medical Care They Will Permit, And The Care That.

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