,,E/ATE ,,PLANN+ ,,= ,,P ,,) ,A ,,*RONIC ,,3DI;N ,,OR ,,4ABIL;Y ,,M>T9 ,M4 ,,%5KMAN1 ,,CPA1 ,,MBA1 ,,JD ,PUBLI%$ 0,DEMOS ,M$ICAL ,PUBLI%+1 ,,LLC1 ,NEW ,YORK ,COPY"R #BJJI 0,DEMOS ,M$ICAL ,PUBLI%+ ,FUR!R REPRODUC;N OR 4TRIBU;N 9 O!R ?AN A SPECIALIZ$ =MAT IS PROHIBIT$4 ,TRANSCRIP;N ( ,,ISBN-#AC3 #IGH-A-ICBFJC-FF-H ,,ISBN-#AJ3 #A-ICBFJC-FF-B ,TRANSCRIB$1 #BJJI1 0,C>OL ,/UD] ,"EGRE5 ,BRL ,S]VICE ,WA%+TON ,TALK+ ,BOOK @& ,BRL ,LIBR>Y ,S1TTLE1 ,WA%+TON ,9 #E VOLUMES ,VOLUME #C ,BRL PAGES P#A-P#F & #AIA-BID ,PR9T PAGES #HD-C#ABD P#A P#B ,SPECIAL ,SYMBOLS ,US$ ,9 ,? ,VOLUME @& AMP]S& 99 A/]ISK _? CROSSHAT* _/ SLA% ,' 7#F1 #C7 TRANSCRIB]'S NOTE SYMBOL ,' 7#F1 #C7 T]M9,N SIGN ,-PUT] ,BRL ,CODE _+ ,2G9 CODE 9DICATOR _: ,5D CODE 9DICATOR . 7#DF7 DOT1 DECIMAL PO9T P#C ,TRANSCRIB]'S ,NOTES ,9CONSI/5CIES ( =MAT O3UR 9 PR9T 9 ! LEGAL DOCU;TS1 ESPECI,Y ": 9=M,N IS 6BE 9S]T$ 7Z 9DICAT$ 0AN A/]ISK74 ,! 9CON- SI/5CIES >E REPRODUC$ 9 BRL ": !Y O3UR4 ,]RORS 9 SPELL+1 PUNCTU,N1 GRAMM> & SYNTAX H1 =! MO/ "P1 BE5 TRANSCRIB$ Z !Y APPE> 9 PR9T4 P#D ,,3T5TS ,*APT] ,PAGE #E ,P[] ( ,ATTORNEY3 ,AU?ORIZ+ ,"S"O 6,TAKE ,LEGAL ,AC;N = ,Y 73T47 """""""""""""""""""""""""""" #HD #F ,5SUR+ ,A3ESS 6,YR ,M$ICAL ,RECORDS3 ,,HIPAA """""""""""""""" #IA #G ,YR ,H1L? ,C>E ,PROXY & ,LIV+ ,W3 ,DESIGNAT+ ,"S"O 6,MAKE ,H1L? ,C>E ,DECI.NS = ,Y """""""" #AJC P#E P#F ,PREP>$ BY #HD ---- .,LAWY]-,"N1 ,ESQ ,,IMM1 ,,G5]AL1 ,,& ,,DURA# ,,P[] ,,( ,,ATTORNEY ,"K ALL P]SONS 0^! PRES5TS1 T ,I 99 .,CLI5T .,"N 7! 8,GRANTOR07 7,SOCIAL ,SECUR;Y ,NUMB]3 99 .,SOCIALSEC71 RESID+ AT 99 .,CLI5T-,A4RESS1 2+ (! AGE ( MA- JOR;Y "U ! LAWS ( 99 .,/ATE"N1 &( SU6I- CI5T CAPAC;Y 63DUCT MY BUSI;S & F9ANCIAL A6AIRS1 9 ORD] 6PROVIDE = MANAGE;T ( ,GRANTOR'S F9ANCIAL1 LEGAL & RELAT$1 AF- FAIRS 9 A M ORD]LY FA%ION1 "HBY DCL Z FOLL[S3 #A4 .,APPO9T;T .( .,AG5T4 ,GRANTOR "H- BY MAKES1 3/ITUTES1 & APPO9TS 78,GRANT07 99 .,AG5T#A-,"N RESID+ AT 99 .,AG5T-#A .,A4RESS1 Z ,GRANTOR'S TRUE & LAW;L ,ATTORNEY-IN-,FACT & AG5T 7! 8,AG5T07 = ,GRANTOR & 9 ,GRANTOR'S "N1 PLACE1 & /1D &= ,GRANTOR'S B5EFIT1 OR ANY #AIA ALT]NATE APPO9T$ 9 A3ORD.E )! A#HD PROVI.NS ( ? ,P[] ( ,ATTORNEY 7! 8,AG5T074 #B4 .,ALT]NATE .,AG5T4 A4 ,IF 99 .,AG5T#A-,"N IS UNWILL+ OR UNA# 6ACT Z ,AG5T1 ,GRANTOR APPO9TS ! F/ P]SON A# & WILL+ 6S]VE F ! FOLL[+ LI/1 Z ,GRANTOR'S ,AG5T 7! 8,ALT]NATE ,AG5T073 ;I4 99 .,AG5T#B-,"N1 :O RESIDES AT 99 .,AG5T-#B,A4RESS4 ;II4 99 .,AG5T#C-,"N1 :O RESIDES AT 99 .,AG5T-#C,A4RESS4 ;III4 99 .,AG5T#D-,"N1 :O RESIDES AT 99 .,AG5T-#D,A4RESS4 B4 ,S* P]SON % S]VE Z ,GRANTOR'S ,AG5T4 ,! TIM+ (! APPO9T;T (! ,ALT]NATE ,AG5T % 2 GOV]N$ 0! PROVI.N 2L1 8,E6EC- TIVE ,DATE40 ,ANY "RS OR P[]S GRANT$ 6! ,AG5T >E GRANT$ 6! ,ALT]NATE ,AG5T1 UN.S SPECIFIC,Y PROVID$ 6! 3TR>Y4 #C4 ..,DIREC;N 6,AG5T 6,SUPPORT ,GRAN- TOR & ,"ND .,P]SONS4 A4 ,! ,AG5T IS "HBY AU?ORIZ$ & DIRECT$ 6P]=M ALL ACTS R1SONA# & NEC 6MA9TA9 ,GRANTOR'S CU/OM>Y /&>D ( LIV+3 #AIB 6PROVIDE LIV+ QU>T]S 0PUR*ASE1 B#HD L1SE1 OR O!R >RANGE;T1 OR 0PAY;T (! OP]- AT+ CO/S ( ,GRANTOR'S EXI/+ LIV+ QU>T]S1 9CLUD+ 9T]E/1 AMORTIZ,N PAY;TS1 REPAIRS1 TAXES1 & S =?2 6PROVIDE =! RET5;N & PAY- ;T ( R1SONABLY NEC DOME/IC HELP =! MA9- T5.E & OP],N ( ,GRANTOR'S H\SEHOLD2 HOME H1L? ASSI/.E & -PANION C>E IF NEC2 6F9.E OR >RANGE =! PUR*ASE ( O!R NECESS>IES1 9CLUD+ B N LIMIT$ 6CLO?+1 TRANSPORT,N1 5T]TA9;T1 & 9CID5TALS2 & 6PROVIDE M$ICAL C>E1 9CLUD+ ! PAY;T = EXP]I;TAL & NOVEL M$IC,NS & TR1T;TS IF APPROV$ 0,GRANTOR'S H1L? C>E AG5T4 B4 ,! ,AG5T IS FUR!R AU?ORIZ$ & DI- RECT$ 6PROVIDE =! H1L?1 $UC,N1 SUPPORT1 & MA9T5.E ( ,GRANTOR'S SP\SE1 & ,GRAN- TOR'S *N 7:E!R OR N S* *N >E M9ORS OR DEP5D5TS1 & EV5 IF ABV ! AGE ( MAJOR;Y71 9 A3ORD.E ) AN ASC]TA9A# /&>D Z DEF9$ 9 ,CODE ,SEC;N #BJDA &! ,REGUL,NS "!"U4 ,GRANTOR RECOGNIZES T S* TRANSF]S 6OR =! B5EFIT ( P]SONS O!R ?AN ,GRANTOR MAY 3/ITUTE GIFTS & AU?ORIZES T S* TRANSF]S 2 P]MITT$ & T S* TRANSF]S N 2 #AIC RE/RICT$ 0! PROVI.NS 2L "U ! CAP- C#HD ;N 8,GIFTS40 ,^! SUPPORT PAY;TS1 H["E1 % N 2 9 EXCESS ( ^? ,GRANTOR HAS TRADI;N,Y PD1 & % GIVE 3SID],N 6ANY WORS5+ ( ,GRANTOR'S H1L? /ATUS &! IMPACT ( T ON ,GRANTOR'S F9.ES4 C4 ,NOT)/&+ ANY?+ 9 ? PROVI.N 6! CON- TR>Y1 NO ,AG5T MAY EX]CISE ANY P[] GRANT$ 9 ? PROVI.N1 OR ELSE": 9 ? ,P[] ( ,ATTORNEY1 9 A MANN] T WD CAUSE ANY ( ,GRANTOR'S ASSETS OR E/ATE 6BE TAXA# 9 ! E/ATE ( ANY ,AG5T4 ,! =EGO+ S5T;E % S]VE Z AN A6IRMATIVE RE/RIC;N & LIMIT,N ON ! "R ( ANY ,AG5T ACT+ "H"U4 D4 ,-;T3 ,ADD PROVI.N & DETAILS 3C]N+ SUPPORT ( ANY PETS4 #D4 .,P[]S .( .,AG5T4 ,! ,AG5T IS "HBY GRANT$ ALL ! P[]S & "RS NEC 6E6ECT ,GRANTOR'S WI%ES1 9CLUD+1 9 A4I;N 6ANY P[] AU?ORIZ$ 0! LAWS ( 99 .,/ATE"N = AN AG5T1 ! FOLL[+3 A4 .,G5]AL .,F9ANCIAL .,MATT]S4 -------------------------------------#HE ;I4 ,REQUE/1 ASK1 DEM&1 SUE =1 RECOV]1 SELL1 BUY1 COLLECT1 =GIVE1 RCV1 & #AID HOLD M"OY1 DEBTS1 DUES1 -M]CIAL A#HE PAP]1 *ECKS1 DRAFTS1 A3.TS1 DEPOSITS1 LEGACIES1 2QUE/S1 DEVISES1 NOTES1 9T]- E/S1 /OCKS1 BONDS1 C]TIFICATES ( DEPOS- IT1 ANNUITIES1 P5.N & RETIRE;T B5EFITS1 9SUR.E PROCE$S1 ANY & ALL DOCU;TS ( TI- TLE2 *OOSE 9 AC;N1 P]SONAL & R1L PROP]- TY1 9TANGI# & TANGI# PROP]TY & PROP]TY "RS2 & DEM& :ATSO"E1 LIQUIDAT$ OR UNLIQ- UIDAT$1 Z N[ >E OR MAY 2COME [N$ BY1 OR DUE1 [+1 PAYA#1 OR 2L;G+ 6,GRANTOR1 OR 9 : ,GRANTOR HAS OR MAY "HAF ACQUIRE 9T]- E/4 ;II4 ,AG5T MAY USE & TAKE ALL LAW;L M1NS & EQUITA# & LEGAL REM$IES1 PROCE- DURES1 & WRITS 9 ,GRANTOR'S "N =! COL- LEC;N & RECOV]Y (! ABV2 & MAY ADJU/1 SELL1 -PROMISE1 & AGREE =! SAME2 & TO MAKE1 EXECUTE1 & DELIV] = ,GRANTOR1 ON ,GRANTOR'S 2HALF & 9 ,GRANTOR'S "N1 ALL 5DORSE;TS1 A3EPT.ES1 REL1SES1 RECEIPTS1 OR O!R SU6ICI5T 4*>GES =! SAME4 B4 .,BUSI;S4 ;I4 ,3DUCT1 5GAGE 9 & TRANSACT ANY LAW;L BUSI;S ( ANY NATURE ON #AIE ,GRANTOR'S 2HALF & 9 ,GRANTOR'S B#HE "N4 ,MA9TA91 IMPROVE1 9VE/1 MANAGE1 IN- SURE1 L1SE1 OR 5CUMB]2 & 9 ANY MANN] D1L ) ANY R1L1 P]SONAL1 TANGI#1 OR 9TANGI# PROP]TY1 OR ANY 9T]E/ 9 !M1 T ,GRANTOR N[ [NS OR MAY ACQUIRE 7OR T AN ,AG5T "H- "U MAY ACQUIRE71 9 ,GRANTOR'S "N &= ,GRANTOR'S B5EFIT1 ^U S* T]MS & 3DI;NS Z ,AG5T % DEEM PROP]4 ;II4 ,3DUCT OR "PICIPATE 9 ANY BUSI;S ( ANY NATURE = ,GRANTOR & 9 ,GRANTOR'S "N2 EXECUTE "PN]%IP AGREE;TS & AM5D;TS "!TO2 9CORPORATE1 REORGANIZE1 M]GE1 CON- SOLIDATE1 RECAPITALIZE1 SELL1 LIQUIDATE1 OR 4SOLVE ANY BUSI;S2 ELECT OR EMPLOY (- FIC]S1 DIRECTORS1 & AG5TS4 ,C>RY \ ! PROVI.NS ( ANY AGREE;T =! SALE ( ANY BUSI;S 9T]E/ OR ! /OCK "!92 & EX]CISE VOT+ "RS ) RESPECT 6/OCK1 EI 9 P]SON OR 0PROXY2 & EX]CISE /OCK OP;NS4 C4 ..,SOCIAL ,SECUR;Y & ,GOV]N;T .,B5- EFITS4 ;I4 ,! ,AG5T MAY APPLY 6ANY GOV]N;TAL AG5CY = ANY B5EFIT OR GOV]N;T OBLIG,N 6: ,GRANTOR MAY 2 5TITL$1 9CLUD+ B N #AIF LIMIT$ 6,SOCIAL ,SECUR;Y1 ,M$I- C#HE C>E1 ,M$ICAID1 & ,VET]ANS B5EFITS IF AP- PLICA#4 ;II4 ,! ,AG5T MAY 5DORSE ANY DRAFTS OR *ECKS MADE PAYA# 6,GRANTOR F ANY S* AG5CY & 6S]VE Z A REPRES5TATIVE PAYEE = ,SOCIAL ,SECUR;Y OR O!R GOV]N;TAL PAY- ;TS4 ,! ,AG5T IS EXPRESSLY AU?ORIZ$ 6EX- ECUTE V\*]S ON ,GRANTOR'S 2HALF = REIM- BURSE;TS PROP]LY PAYA# 6,GRANTOR 0! ,UNIT$ ,/ATES GOV]N;T OR ANY AG5CY "!( OR ANY /ATE AG5CY4 ,! ,AG5T IS EXPRESSLY AU?ORIZ$ 6*ANGE ,GRANTOR'S A4RESS =! PURPOSE ( RCVG *ECKS1 MAIL1 OR O!R MAT- T]S F ! ,SOCIAL ,SECUR;Y ,ADM9I/R,N OR ANY O!R GOV]N;TAL AG5CY4 D4 ..,3TRACT1 ,R1L ,E/ATE1 & ,O!R .,MATT]S4 ;I4 ,! ,AG5T MAY EX]CISE OR P]=M ANY ACT1 P[]1 DUTY1 "R1 OR OBLIG,N T ,GRAN- TOR N[ HAS1 OR MAY ACQUIRE1 9CLUD+ ! LE- GAL "R1 P[]1 OR CAPAC;Y 6EX]CISE OR P]=M 9 3NEC;N )1 >IS+ F1 OR RELAT+ 6ANY P]SON OR PROP]TY1 R1L OR P]SONAL1 TANGI# OR 9TANGI#1 OR MATT] :ATSO"E4 #AIG ;II4 ,? 9CLUDES1 )\T LIMIT+ ! D#HE =EGO+1 ! "R 6EXECUTE A DE$ OR SECUR;Y AGREE;T2 6REL1SE A SECUR;Y AGREE;T2 65T] 96A L1SE1 OP;N1 MORTGAGE OR SIMIL> >- RANGE;T2 65T] 96A 3TRACT ( SALE & 6SELL OR PUR*ASE ANY R1L1 P]SONAL1 TANGI#1 OR 9TANGI# PROP]TY ON ,GRANTOR'S 2HALF4 ;III4 ,-;T3 ,3SID] LI/+ SPECIFIC PROP- ]TIES : ! AG5T MAY SELL OR ACT ^U4 ,9 AD- DI;N1 3SID] LI/+ ANY PROP]TY : Y D N WANT ! AG5T 6SELL OR ACT ^U4 ,! A=EM5;N$ P[]S % APPLY1 0WAY ( EXAMPLE & N LIMITA- ;N1 6! PROP]TY 7PROP]TIES7 LOCAT$ AT 99 .,CLI5T-,A4RESS & 99 .,O!R .,PROP]TY4 E4 .,SECURITIES .& .,9VE/;TS4 ;I4 ,MAKE1 RCV1 SIGN1 5DORSE1 AC"KL- $GE1 DELIV]1 & POSSESS DOCU;TS ( TITLE1 BONDS1 DEB5TURES1 *ECKS1 DRAFTS1 /OCKS1 PROXIES1 OR W>RANTS1 RELAT+ 6A3.TS OR DEPOSITS1 OR C]TIFICATES ( DEPOSIT1 O!R DEBTS & OBLIG,NS1 & S* O!R 9/RU;TS 9 WRIT+ ( :AT"E K9D & NATURE Z MAY 2 NEC OR PROP] 9 ! EX]CISE (! "RS & P[]S "H9 GRANT$4 ;II4 ,SELL1 OR PUR*ASE ANY & #AIH ALL %>ES ( /OCKS1 BONDS1 OR O!R E#HE SECURITIES N[ OR LAT] 2L;G+ 6,GRANTOR T MAY 2 ISSU$ 0ANY ASSOCI,N1 TRU/1 OR COR- POR,N1 :E!R PRIVATE OR PUBLIC2 & MAKE1 EXECUTE1 & DELIV] ANY ASSIGN;T1 OR AS- SIGN;TS1 ( ANY S* %>ES ( /OCKS1 BONDS1 OR O!R SECURITIES4 -------------------------------------#HF F4 .,MOTOR .,VEHICLES4 ,APPLY = ANY C]TIFICATE ( TITLE1 [N]- %IP1 OR LIC5SE2 5DORSE & TRANSF] TITLE REG>D+ ANY AUTOMOBILE1 MOTORCYCLE1 OR O!R MOTOR VEHICLE OR BOAT4 G4 .,LEGAL .,AC;NS4 ;I4 ,SETTLE1 ADJU/1 -PROMISE1 OR SUB- MIT 6>BITR,N ANY A3.TS1 CLAIMS1 DEBTS1 DEM&S1 4PUTES1 OR O!R MATT]S 2T ,GRANTOR & ANY O!R P]SON OR 5T;Y1 OR : 3C]N ANY PROP]TY1 "R1 TITLE1 9T]E/1 OR E/ATE4 ,2G91 PROSECUTE1 5=CE1 AB&ON1 DEF5D1 OR SETTLE ALL CLAIMS OR JUDICIAL OR ADM9IS- TRATIVE PROCE$+S4 ;II4 ,EXECUTE & FILE DOCU;TS 6TOLL ANY /ATUTE ( LIMIT,NS4 ,GRANTOR RECOGNIZES T ! 9CLU.N (! LATT] PHRASE MAY S]VE #AII 6PREV5T ! TOLL+ (A /ATUTE ( LIMI- A#HF T,NS OR O!R D1DL9E : WD O!RWISE 2 TOLL$ P5D+ ,GRANTOR'S 4ABIL;Y4 H4 ..,RETIRE;T1 ,,IRA1 & ,O!R ,B5EFIT ,PLANS & ,B5EFICI>Y .,DESIGN,NS4 ;I4 ,-;T3 ,2 C]TA9 T Y "U/& ! 3SEQU;ES ( ? P>AGRAPH4 ,*ANG+ B5EFICI>Y DESIGN,NS ON RETIRE;T & P5.N A3.TS C H PROF.D TAX 3SEQU;ES1 C *ANGE ! 4POSITIVE S*EME (! L>GE/ ASSET 9 YR E/ATE4 ;II4 ,REDEEM1 BORR[1 AM5D1 C.EL1 PL$GE1 SURR5D]1 ALT]1 OR *ANGE ! B5EFI- CI>Y ( ANY RETIRE;T1 B5EFIT1 P5.N PLAN OR O!R PLAN OR A3.T HAV+ A B5EFICI>Y DESIGN,N =M4 ;III4 ,H["E1 ? P[] MAY N 2 EX]CIS$ BY ANY AG5T :O IS A B5EFICI>Y 7OR SP\SE (A B5EFICI>Y7 9 A MANN] : 4PROPOR;NATELY 7Z -P>$ 6! 3SEQU;ES (! B5EFICI>Y DESIGN,N EXI/+ PRIOR 6! AG5T 9/ITUTE *ANGE7 B5E- FITS S* AG5T 7OR ! SP\SE ( S* AG5T74 ;IV4 ,DESIGNATE 6! EXT5T ,GRANTOR CD "O OR M P]SONS 79CLUD+ TRU/S7 Z DESIG- NAT$ B5EFICI>IES ( ANY S* PLAN4 ,SELECT ANY PAY-\ RATE OR ELEC;N P]MITT$ #BJJ 6,GRANTOR4 B#HF I4 ..,EMPLOY;T ( ,A3.TANTS1 ,ADVIS]S1 & .,O!RS4 ,EMPLOY & -P5SATE 9VE/;T ADVIS]S1 BANKS1 A3.TANTS1 EXP]T WIT;S1 ATTORNEYS1 R1L E/ATE & O!R BROK]S1 & O!R PROFES.N- ALS OR ASSI/ANTS 6SAME1 :OM ! ,AG5T REA- SONABLY DEEMS NEC4 ,6CAUSE S* P]SONS TO PREP>E REPORTS OR ANALYSIS1 & 6ACT 9 R1SONA# RELI.E ^U SAME1 & 6FURNI% ANY ?IRD "PY ,AG5T 2LIEVES NEC OR APPROPRI- ATE S* REPORTS OR ANALYSIS4 ,"! % 2 NO RE/RIC;N ON ! ,AG5T HIR+ OR N HIR+ ! AD- VIS]S : GRANTOR US$4 J4 .,SAFE .,DEPOSIT .,BOX4 ,H A3ESS AT ANY "T OR "TS 6ANY SAFE DEPOSIT BOX R5T$ 0,GRANTOR1 OR = : ,GRANTOR IS A CO-T5ANT2 REMOVE ALL OR ANY "P (! 3T5TS "!(1 & SURR5D] OR REL9- QUI% ANY SAFE DEPOSIT BOX4 ,NO 9/ITU;N 9 : ANY SAFE DEPOSIT BOX MAY 2 LOCAT$ % 9CUR ANY LIABIL;Y 6,GRANTOR OR ,GRAN- TOR'S E/ATE Z A RESULT ( P]MITT+ ! ,AG5T 6EX]CISE ! P[]S "H9 GRANT$4 #BJA K4 .,GIFTS4 C#HF ,! ,AG5T % N H ANY AU?OR;Y 6MAKE GIFTS4 L4 ..,TRANSF] ( ,PROP]TY 6.,TRU/4 ,) RESPECT 6A REVOCA# LIV+ TRU/ =! B5- EFIT ( ,GRANTOR ! ,AG5T MAY 3VEY1 TRANS- F] OR ASSIGN ANY CA%1 R1L E/ATE OR O!R TANGI# OR 9TANGI# PROP]TY 9 : ,GRANTOR % [N ANY 9T]E/ 6! TRU/EE OR TRU/EES ( ANY TRU/ T ,GRANTOR MAY H CR1T$ DUR+ ,GRAN- TOR'S LIFE"T1 PROVID$ T S* TRU/ IS SUB- JECT 6,GRANTOR'S P[] ( REVOC,N4 M4 .,PO/AL .,MATT]S4 ,6EXECUTE ANY DOCU;TS NEC OR APPROPRI- ATE 6SECUR+ A PO/AL BOX1 *ANG+ OR COR- RECT+ A PO/AL MAIL+ A4RESS1 & MAK+ PAY- ;TS = SAME4 ,0WAY ( EXAMPLE & N LIMIT,N1 ? P[] % EXPRESSLY 9CLUDE ! "R 6REDIRECT MAIL F ANY =M] RESID;E OR PO/-(FICE BOX 6A NEW A4RESS OR PO/-(FICE BOX : ! ,AG5T R1SONABLY 2LIEVES W FACILITATE ! MANAGE- ;T ( ,GRANTOR'S ASSETS1 TAX1 LEGAL & O!R MATT]S4 ,ANY ?IRD "PY1 9CLUD+ B N LIMIT$ 6! ,UNIT$ ,/ATES GOV]N;T & ANY AG5CY "!- (1 >E DIRECT$ 6AD"H 6S* REQUE/S ( #BJB ! ,AG5T & >E 9DEMNIFI$ & HELD D#HF H>M.S = SAME4 N4 .,BOND4 ,NO BOND OR SECUR;Y ( ANY K9D % 2 RE- QUIR$ 9 ANY JURISDIC;N ( ANY ,AG5T ACT+ "H"U4 ,IF ANY BOND IS REQUIR$ 0LAW1 /AT- UTE OR RULE ( C\RT1 NO SURETIES % 2 RE- QUIR$ "!ON4 ,H["E1 IF ANY ,AG5T DEEMS X APPROPRIATE 9 S* ,AG5T'S 4CRE;N 6OBTA9 A BOND1 S* BOND MAY 2 PD PURSUANT 6! P[]S GRANT$ "H"U4 -------------------------------------#HG O4 .,9SUR.E4 ;I4 ,MAKE1 RCV1 SIGN1 5DORSE1 AC"KL- $GE1 DELIV]1 & POSSESS 9SUR.E POLICIES4 ,EXECUTE ANY =MS 6*ANGE [N]%IP OR B5E- FICI>IES ( ANY LIFE 9SUR.E POLICY ON ,GRANTOR'S LIFE4 ;II4 ,H["E1 NEW B5EFICI>IES MAY 9CLUDE ONLY3 ,AU?ORIZ$ ,DONEES1 A TRU/ = : ,AU- ?ORIZ$ ,DONEES >E ! PRIM>Y B5EFICI>IES1 A CORPOR,N OR "PN]%IP 9 : ,GRANTOR IS A %>EHOLD] OR "PN]1 ANO!R %>EHOLD] OR "PN] 9 A CORPOR,N OR "PN]%IP 9 : ,GRANTOR IS A %>EHOLD] OR "PN]1 ,GRANTOR'S #BJC E/ATE1 OR ANY TRU/ ( : ,GRANTOR A#HG IS A GRANTOR1 TRU/EE1 OR B5EFICI>Y4 #E4 ..,P[]S ,RELAT+ 6,TAX .,MATT]S4 A4 ,9 A4I;N TO1 & N 0WAY ( LIMIT,N ^U1 ANY O!R P[]S 3F]R$ ^U ,GRANTOR'S ,AG5T "H91 ,GRANTOR GRANTS 6! ,AG5T FULL P[] & AU?OR;Y 6D1 TAKE1 & P]=M EA* & E ACT & ?+ : IS R1SONABLY REQUIR$1 PROP]1 OR NEC 6BE D"O 9 3NEC;N )! 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LAWS ( 99 .,/ATE .,"N1 D "HBY DCL Z FOLL[S3 #A4 .,APPO9T;T .( .,AG5T4 ,I "HBY MAKE1 3/ITUTE1 & APPO9T 78,GRANT07 99 .,AG5T .#A .,"N4 RESID+ AT OR DO+ BUSI;S AT 99 .,AG5T .#A .,A4RESS 6BE MY AG5T "U ! ,H1L? ,9SUR.E ,PORTABIL;Y & ,A3.TABIL;Y ,ACT ( #AIIF1 #DB ,,USC #ACJ;D & #DE ,,CFR #AFJ-AFD1 & 9 "PICUL> XS #BJJC ,PRIVACY ,REGUL,NS 78,,HIPAA07 78,AG5T074 #B4 .,P[]S .( .,AG5T4 ;I4 ,MY AG5T % 2 TR1T$ Z ,I WD ) REG>D 6! USE & 4SEM9,N ( MY 9DIVIDU,Y ID5TIFI- A# H1L? 9=M,N & M$ICAL RECORDS4 ;II4 ,? AU?OR;Y APPLIES 6ANY 9=M,N GOV]N$ 0! ,,HIPAA RULES & #BCA REGUL,NS4 ,I SPECIFIC,Y AU?ORIZE A#II ANY H1L? PLAN1 PHYSICIAN1 D5TI/1 H1L? C>E PROFES.NAL1 HOSPITAL1 CL9IC1 LABORA- TORY1 PH>MACY1 M$ICAL FACIL;Y1 9SUR.E -PANY &! ,M$ICAL ,9=M,N ,BUR1U ,9C41 OR ANY O!R H1L? 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DATE "H( B H 9T5;N,Y *OS5 N 6D S4 B4 ,I H DECID$ T X % REMA9 9 #BCF FULL =CE & E6ECT = Z L;G Z ,I C#AJJ MAY LIVE UN.S T]M9AT$ Z PROVID$ 2L4 C4 ,UN.S ? ,AU?ORIZ,N IS REVOK$ 9 WRIT+ 0ME1 ) ACTUAL DELIV]Y ( SD REVOC,N 6! P]SON OR 5T;Y 9 "Q1 X % 3T9UE 6BE 9 =CE & E6ECT & % EXPRESSLY N EXPIRE4 #AA4 .,REVOC,N4 ,I "U/& T A REVOC,N IS N E6ECTIVE 6! EXT5T T ANY ( MY ,PROVID]S H RELI$ ON ?4 #AB4 .,REDISCLOSURE4 ,I "U/& T ANY 9=- M,N T IS 4CLOS$ PURSUANT 6? AU?ORIZ,N MAY 2 RE-4CLOS$ & NO L;G] COV]$ 0F$]AL RULES GOV]N+ PRIVACY & 3FID5TIAL;Y ( H1L? 9=M,N4 #AC4 .,T]M9,N4 A4 ,? ,AU?ORIZ,N % 2 MODIFI$ OR T]MI- NAT$1 Z ! CASE MAY BE1 ^U MY EXECUT+ A T]M9,N DOCU;T OR ^U MY EXECUT+ A WRITT5 NOTICE ( MODIFIC,N OR T]M9,N & S* ,AG5T'S RECEIPT ( SAME4 ,I RECOGNIZE T %D ,I LACK ! -PET5CY 6REVOKE ? ,AU?ORI- Z,N1 AT T FUTURE PO9T 9 "T ? #BCG ,AU?ORIZ,N W N 2 A# 6BE REVOK$4 D#AJJ ,I EXPRESSLY 9T5D ? RESULT & REQUE/ T ANY M$ICAL PROVID] RESPECT ? 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USES & PURPOSES "!9 EXPRESS$4 ---- ,NOT>Y ,SIGNATURE #BCI B#AJA #BDJ ,,*APT] #G #AJB-AJC ,YR ,H1L? ,C>E ,PROXY & ,LIV+ ,W ,DESIGNAT+ ,"S"O 6,MAKE ,H1L? ,C>E ,DECI.NS = ,Y ,9TRODUC;N 6,H1L? ,C>E ,PROXIES & ,LIV+ ,WILLS ,A H1L? C>E PROXY IS A LEGAL DOCU;T 9 : Y DESIGNATE A TRU/$ P]SON 7AG5T7 6MAKE H1L? C>E DECI.NS = Y IF Y >E UNA# 6D S YRF 2C ( ILL;S OR 4ABIL;Y4 ,A LIV+ W IS A /ATE;T T DEF9ES YR H1L? C>E WI%ES4 ,AL? ! TWO DOCU;TS >E 9TEGR,Y RELAT$1 HAV+ !M PREP>$ & EXECUT$ Z 9DEP5D5T DOC- U;TS MAY FACILITATE _! USE 9 _M 9/.ES4 ,"S H1L? C>E PROVID]S PREF] A H1L? C>E PROXY S T !Y C H YR "ND AG5T EXECUTE DOCU;TS 3FIRM+ H1L? C>E DECI.NS4 ,9 O!R SITU,NS1 HOSPITALS OR M$ICAL FACILITIES MAY 9SI/ ON A LIV+ W SIMPLY 2C ( _! POL- ICIES4 ,9 _M 9/.ES1 A DETAIL$ P]SONALIZ$ EXPLAN,N ( YR H1L? C>E WI%ES1 Z #BDA PROVID$ 0A LIV+ W1 MAY 2 ESS5- A#AJC TIAL 6PROVIDE GUID.E 6^? MAK+ DECI.NS = Y4 ,! FOCUS (! H1L? C>E PROXY IS = Y 6AP- PO9T "S"O Z YR AG5T 6MAKE H1L? C>E DECI- .NS4 ,"S /ATES D N AF=D ! SAME RECOGNI;N 6A LIV+ W Z !Y D 6A H1L? C>E PROXY4 ,9 ^? /ATES1 ! H1L? C>E PROXY EMP[]+ YR AG5T W 2 ! ONLY DOCU;T ) LEGAL WEIE DECI.NS1 X %D 2 PREP>$ 9 A MANN] T PRES5TS 8CLE> & 3V9C+0 PRO( ( YR WI%ES4 ,VAGUE & G5]AL ------------------------------------#AJD /ATE;TS Z TO 8NO H]OIC M1SURES0 &! L1 : >E TYPIC,Y US$ 9 _M BOIL]PLATE LIV+ WILLS MAY N SU6ICE4 ,"!=E1 ! SAFE/ AP- PROA* IS = Y 6SIGN BO? A LIV+ W &A H1L? C>E PROXY1 MAK+ C]TA9 T YR WI%ES >E CLE>LY & 3V9C+LY /AT$1 & H EA* (! DOCU- ;TS WIT;S$ & NOT>IZ$ SEP>ATELY4 ,6BE 8CLE> & 3V9C+0 W (T5 REQUIRE Y 6ELABO- RATE ON ! /&>D LANGUAGE _M =MS #BDB 3TA94 ,? IS ESPECI,Y IMPORTANT 9 A#AJD LIE PROXY S T !Y CLE>LY %[ H[ YR *RONIC ILL;S IMPACTS YR DIREC- TIVES4 ,! H1L? C>E PROXY 7P[] ( ATTORNEY = M$ICAL DIRECTIVES7 PROVIDES A ME*ANISM = DECI.NS 6BE MADE 0YR *OS5 REPRES5TATIVES IF1 :51 & ": ! NE$ EXI/S4 ,X IS IMPOSSI# 6=ESEE E POSSI# FUTURE ILL;S OR E POSSI# TR1T;T YR DOCTORS MAY PRESCRIBE NO MATT] H[ 8CLE> & 3V9C+0 Y TRY 6MAKE ! LANGUAGE 9 YR DOCU;T4 ,0APPO9T+ A P]SON 6ACT 9 YR 2HALF1 Y 5SURE T ^! DECI.NS C 2 MADE BAS$ ON YR 3DI;N AT A GIV5 "T & T ! DE- CI.NS AB AVAILA# M$ICAL PROC$URES & REC- OMM5D,NS >E MADE 9 A3ORD.E ) YR WI%ES4 ,EXAMPLE ,Y MIE T DI6] 7MODE/LY OR SUB/ANTI,Y7 F ! /&>D LANGUAGE & EXPLAN,NS T MO/ #BDC ATTORNEYS NORM,Y USE 6DEF9E !M4 B#AJD ,MO/ P SIGN+ ^! DOCU;TS H NO IDEA :AT1 IF ANY1 H1L? ISSUES MAY A6ECT !M 9 ! FU- TURE1 & ? IS :Y MO/ =MS >E S G5]IC4 ,= P ) *RONIC ILL;SES1 ! P>ADIGM IS DI6]5T4 ,Y LIKELY H SIGNIFICANT K ( YR CURR5T 3DI;N & MO/ LIKELY H A PRETTY GD IDEA AB LIKELY FUTURE H1L? ISSUES4 ,USE ? K TO TAILOR /&>D =MS4 ,DON'T A3EPT G5]IC LANGUAGE T RE,Y DOESN'T A4RESS YR 3C]NS4 ,X IS AL IMPORTANT 6MAKE ROOM = HOPE 9 YR DOCU;TS4 ,"! IS FASC9AT+1 CUTT+-$GE RESE>* 2+ 3DUCT$ T MAY WELL RESULT 9 A BR1K"? = YR "PICUL> ILL;S4 ,9 ! EV5T A SIGNIFICANT BR1K"? O3URS1 X IS IMPORTANT = YR AG5T 6H ! FLEXIBIL;Y 6REACT & *ANGE DECI.NS MADE 2F ! BR1K"?4 ------------------------------------#AJE ,IMPORT.E ( ,YR ,LIV+ ,W ,A LIV+ W IS "O (! MO/ IMPORTANT & P]- SONAL DOCU;TS T Y W "E SIGN4 ,X IS AL "O (! MO/ 3TROV]SIAL1 MIS"U/OOD1 & MISAP- PLI$ LEGAL DOCU;TS4 ,Z ) TOO _M IMPOR- TANT DECI.NS1 LIV+ WILLS H 2COME #BDD A 8QK FIX0 T SELDOM A4RESS "EY?+ A#AJE T %D 2 A4RESS$4 ,"H >E "S (! MISTAKES T P MAKE ) LIV+ WILLS3 ,SIGN A QK "O-PAGE /&>D =M ) YR LAWY] & YR WORRIES >E OV]4 ,UN=TUNATELY1 IM- PORTANT LEGAL1 F9ANCIAL1 RELIGI\S1 & M$ICAL ISSUES W N 2 A4RESS$ UN.S Y >E PROACTIVE4 ,AN EV5 WORSE APPROA* IS 6USE A =M Y PUR*ASE ON ! 9T]NET4 ,MO/ ( ^! =MS >E S G5]IC & S POORLY DRAFT$ T EXTREME CAU;N IS 9 ORD]4 ,! WOR/ APPROA* ( ALL IS 6SIGN A =M A HOSPITAL EMPLOYEE H&S Y :5 Y >E ADMIT- T$ 2C Y'VE TAK5 NO AC;N 9 ADV.E4 ,RE- G>D.S (! QUAL;Y (A HOSPITAL PROVID$ =M1 SIGN+ A DOCU;T DUR+ ! *AOS & /RESS ( AN EM]G5CY HOSPITAL ADMIS.N IS N"E WISE4 ,! 9=M,N PROVID$ 2L W GUIDE Y "? ! PROCESS ( PROP]LY -MUNICAT+ YR WI%ES4 ,X W EXPLA9 H[ Y C OBTA9 ! BE/ PROTEC;N & -=T F YR LIV+ W & H1L? C>E PROXY #BDE 9 A SIMPLE & PRACTICAL MANN]4 ,X B#AJE W AL GIVE Y ID1S H[ 6TAILOR ^! DOCU;TS 6REFLECT "S (! UNIQUE ISSUES CR1T$ 0YR SPECIAL SITU,N4 ,"! >E V>I\S ME?ODS ( -MUNICAT+ YR WI%ES 6! ATTORNEY Y >E "W+ )1 & ? PROCESS %D 2G9 ) ID5TIFY+ "QS OR 3C]NS Y MAY H4 ,) ? ATT5;N 6DETAIL1 YR ATTORNEY C M ?OR\,N (A -PREH5SIVE LIV+ W & H1L? C>E PROXY4 ,ONCE ? PROCESS IS COM- PLET$1 ! F9AL =MS W HELP Y 9=M & GUIDE YR FAMILY1 LOV$ "OS1 & H1L? C>E PROVID]S 9 MAK+ _M VITAL M$ICAL DECI.NS4 ,YR DOC- U;TS %D M9IMIZE ! LEGAL 9T]F];E & -PLI- C,NS ( C>RY+ \ YR WI%ES4 ------------------------------------#AJF ,:Y ,Y ,NE$ ,A ,LIV+ ,W & ,H1L? ,C>E ,PROXY ,DECID+ H[ Y %D 2 C>$ = 9 ! EV5T (A M$I- CAL CRISIS RELAT$ 6YR *RONIC ILL;S1 ! DET]IOR,N ( YR 3DI;N1 OR EV5 AN UNRELAT$ M$ICAL EV5T1 IS EXTRAORD9>ILY DI6ICULT & EMO;NAL4 ,! IMPORT.E ( MAK+ YR WI%ES AB H1L? C>E TR1T;T "KN 9 ! EV5T Y >E #BDF UNA# 6-MUNICATE YR DECI.NS :5 Y A#AJF >E GRAVELY ILL HAS 2COME AN 9TEGRAL "P ( E/ATE & P]SONAL PLANN+ = "EY"O4 ,)\T AD- V.E PREP>,N1 LIV+ WILLS & H1L? C>E PROX- IES 7! DOCU;TS US$ 6-MUNICATE YR H1L? C>E WI%ES71 YR H1L? C>E WI%ES MAY N 2 C>RI$ \4 ,)\T PROP] DOCU;T,N1 YR FAMILY OR LOV$ "OS MAY FACE GUT-WR5*+ DECI.NS AB YR C>E4 ,"! IS NO SOLACE 6BE F.D 9 "K+ :AT Y WD H WANT$ & N 2+ A# 6ACT 7OR N ACT7 ON T K4 ,9 "S CASES1 FAMILY MEMB]S & LOV$ "OS D N "K :AT Y WANT1 & ? MAKES DECI.N MAK+ EV5 M DI6ICULT4 ,?9K+ AB & 4CUSS+ T]M9AL ILL;S & D1? C N"E 2 A PL1SANT OR EASY MATT]4 ,H["E1 YR FAILURE 6PROVIDE YR LOV$ "OS ) GUID.E N[1 :ILE Y >E A# TO1 MAY CAUSE !M 6H 6SECOND-GUESS :AT Y WD H WANT$ D"O4 ,? W 2 A F> M DI6ICULT & EMO- ;N,Y TRAUMATIC TASK = !M4 ,X IS ?US ESS5TIAL 6-MUNICATE GUIDE- L9ES1 9 WRIT+1 AB H[ Y WANT 6BE C>$ = 9 ! EV5T (A M$ICAL EM]G5CY1 DET]IOR,N ( YR 3DI;N 7:E!R ANTICIPAT$ OR UNEXPECT$71 OR YR T]M9AL ILL;S4 ,!Y M/ H ! LEGAL #BDG AU?OR;Y 6D S4 ,N -PLET+ ? ADMIT- B#AJF T$LY UNPL1SANT PROCESS N[ C ONLY CR1TE M CO/S1 DI6ICULTIES1 & UNPL1SANT;S LAT]--= Y & YR LOV$ "OS4 ,YR P]SONAL GOALS W 2 -PROMIS$ & Y MAY SP5D ! F9AL MON?S OR YE>S ( YR LIFE 9 AGONY OR 3FRONT+ QUAL;Y-(-LIFE ISSUES T >E UNA3EPTA#4 ,IF Y D N A4RESS LIV+ W & RELAT$ H1L? C>E ISSUES N[1 Y L1VE YRF OP5 6HAV+ DOC- TORS1 C\RTS1 OR O!RS MAK+ DECI.NS = Y1 (T5 ) RESULTS T Y WD N H *OS54 ,REMEMB] Y H A 4T9CT ADVANTAGE OV] ^? P :O D N "K :AT LIES AH1D 2C YR K AB YR CURR5T ILL;S &! C\RSE X MAY TAKE C HELP Y MAKE *OICES AB _M (! M$ICAL ISSUES T W A6ECT Y 9 ! FUTURE4 ------------------------------------#AJG ,:Y ,A ,-PREH5SIVE ,DOCU;T ,IS ,IMPORTANT ,! K9D ( DOCU;T RECOMM5D$ 9 ? 4CUS.N IS M -PREH5SIVE ?AN :AT IS PROVID$ 9 _M (! -M]CIAL =MS Y C PUR*ASE 9 (FICE SUPPLY /ORES OR OBTA9 F V>I\S ORGANIZ,NS4 ,(T5 ! -M]CIAL =MS >E LIMIT$ 6SIMPLE #BDH 9/RUC;NS S* Z 8PULL+ ! PLUG0 9 ! A#AJG EV5T (A T]M9AL ILL;S4 ,? LANGUAGE C 2 "PICUL>LY DANG]\S4 ,YR *RONIC ILL;S MAY 2 8T]M9AL10 B Y MAY H A NE>LY NORMAL LIFE EXPECTANCY ( _M DECADES4 ,! SIM- PLI/IC LANGUAGE 9 _M /&>D =MS MID =M MIE OR 9T]V5;N %D 2 PROVID$4 ,IF Y WANT PROTEC;N AG/ ? K9D ( AMBIGU;Y & LACK ( PRECI.N1 Y NE$ A M* M -PREH5SIVE DOCU;T4 ,! =M Y USE M/ A4RESS YR P]SONAL NE$S & 3C]NS1 N SIMPLY A G5]IC LI/ ( *OICES4 ,YR P]SONAL PREF];ES1 RELIGI\S 3C]NS1 FAMILY1 & O!R P]SONAL REL,N%IPS %D ALL 2 3SID]$4 #BDI ,*OOS+ ,YR ,H1L? ,C>E ,AG5T B#AJG ,*OOS+ :OM 6APPO9T Z YR AG5T C 2 V DI6I- CULT4 ,_M LOV$ "OS1 H["E S5SITIVE 6YR FEEL+S1 MAY SIMPLY N 2 A# 6MAKE ! V DIF- FICULT DECI.NS T MIE TWO IMPORTANT R1SONS = ?1 ! MO/ OBVI\S 2+ T MAK+ DECI.NS 9 A CRISIS IS DI6ICULT 5 )\T HAV+ 6MAKE A DECI.N ) "S- "O :O MAY ------------------------------------#AJH 4AGREE ) Y4 ,FUR!RMORE1 "S /ATE LAWS PROHIBIT JO9T AG5TS1 : W MAKE ! APPO9T;T 9E6ECTUAL4 ,IF Y WANT 6"N TWO P 6MAKE DECI.NS1 "N !M SEQU5TI,Y 7T IS1 ! SECOND ONLY C S]VE IF ! F/ _C74 ,Y C !N ADD NONB9D+ LANGUAGE 6! H1L? C>E #BEJ PROXY SU7E/+1 B N REQUIR+1 T ALL A#AJH AG5TS 3SULT EA* O!R 7IF F1SI#7 2F ACT+4 ,? RECOMM5D,N MIATE LR ( 9/RUC;N1 A TACTIC T ALL[S Y 6EXPRESS YR WI%ES )\T 9VIT+ UNNEC LEGAL ISSUES4 ,D N NECESS>ILY ASSUME T ! P]SON Y SE- LECT W 2 A# 6C>RY \ YR WI%ES4 ,"S PRO- SPECTIVE AG5TS MAY H RELIGI\S1 MORAL1 OR O!R P]SONAL R1SONS = N 2+ WILL+ 6C>RY \ C]TA9 WI%ES4 ,= EXAMPLE1 _M P SIMPLY D N H ! EMO;NAL -POSI;N TO 8PULL ! PLUG40 ,Y %D 4CUSS ^! IMPORTANT MATT]S ) E POT5- TIAL AG5T OR SU3ESSOR AG5T 9 ADV.E4 ,Y %D AL REQUE/ P]MIS.N F ! P Y WANT 6"N Z YR AG5T OR SU3ESSOR AG5T2 ! P]SON AP- PO9T$ %D N 4COV] HE HAS BE5 APPO9T$ VIA A PH"O CALL F "S HOSPITAL 9 ! MI4LE (! NIE;L 9 NAM+ A * 6MAKE YR H1L? C>E DECI.NS4 ,_M *N1 EV5 ^? :O H L;G AGO R1*$ ! AGE ( MAJOR;Y1 H A V DI6ICULT "T MAK+ T\< M$ICAL DECI.NS =A P>5T1 ESPE- CI,Y AN 5D-(-LIFE DECI.N4 ,IF Y WANT 6"N *N1 F9D \ 9 ADV.E :E!R !Y >E #BEA -=TA# ) A3EPT+ ? RESPONSIBIL;Y & B#AJH ! *OICES X MIANTEE T ! RE- QUIR$ DECI.NS W N 2 MADE 9 "T4 ,3SID] YR /ATE'S H1L? C>E /ATUTES = ANY REQUIRE;TS T !Y MAY IMPOSE ON H1L? C>E AG5TS4 ,YR ATTORNEY C ADVISE Y AB ?1 OR Y C REVIEW ! /ATUTE BOOKS AT YR LOCAL LIBR>Y OR ONL9E4 ,F9D A WEB SITE 7PREF]- ABLY AN (FICIAL /ATE WEB SITE7 T COV]S /ATE LAWS & RESE>* YR /ATE'S POLICIES ON LIV+ WILLS1 H1L? C>E AG5TS1 OR SIMIL> SUBJECTS4 ------------------------------------#AJI ,A4I;NAL ,DECI.NS ,Y ,%D ,MAKE ,"! >E A HO/ ( SIGNIFICANT #BEB P]SONAL DECI.NS Y M/ MAKE 6BE/ A#AJI PROTECT YR WI%ES4 ,^! DECI.NS %D REFLECT ANY NU.ES ( YR CURR5T & ANTICIPAT$ H1L? /ATUS4 ,! P>AGRAPHS 2L PROVIDE EXAMPLES ( -MON ISSUES T A6ECT DECI.NS MADE 0P ) *RONIC ILL;SES4 ,NO ,H]OIC ,M1SURES OR ,ALL ,M1SURES ,%D ME*ANICAL M1NS ( PROL;G+ YR LIFE 2 US$8 ,"O DI6ICULTY 9 A4RESS+ ? "Q IS T X IS IMPOSSI# 6"K : TR1T;TS W 2 NEC OR AVAILA#4 ,FUR!RMORE1 H[ D Y DEF9E 8H]O- IC08 ,:AT IS H]OIC 9 "O SITU,N MAY N 2 H]OIC 9 ANO!R4 ,IF Y H ,,ALS1 Y W ASSUR- $LY NE$ ASSI/.E BR1?+ AT "S PO9T1 & /&>D =MS M&AT+ 9TUB,N OR NO 9TUB,N MAY N 2 PRECISE 5 6REFLECT YR WI%ES4 ,ON ! O!R H&1 "S =MS GET Q SPECIFIC1 GIV+ Y A COM- PLEX GRID ( BOXES 6*ECK (F ! TYPES ( M$- ICAL PROC$URES Y WANT OR DON'T WANT1 BAS$ ON V>I\S HYPO!TICAL SC5>IOS4 ,B :AT HAPP5S IF YR SC5>IO IS J A LL DI6]5T F :AT'S 9 ! BOXES8 ,:AT %D YR AG5T D !N8 ,9 "S CASES1 HAV+ TOO _M *OICES IS WORSE ?AN HAV+ N"O4 ,9 O!R CASES1 N EV5 #BEC A =M T COV]S HUNDR$S OR ?\S&S ( B#AJI OP;NS & POT5TIAL SC5>IOS C GET X "R--"! IS SIMPLY NO GU>ANTEE T X W A4RESS ! UNIQUE NU.ES ( YR *RONIC ILL;S OR "S UN- ANTICIPAT$ TURN ( EV5TS4 ,3SID] DI6]5T OP;NS & PROVI.NS & MAKE ! *OICES T >E BE/ = Y4 ,REVIEW ^! *OICES ) YR H1L? C>E PROVID]2 YR DOCTORS & O!RS MAY HELP Y REF9E YR DECI.NS4 ,IF YR RELIGION IS AN IMPORTANT "P ( YR LIFE1 Y MAY WANT 6CON- SULT ) CL]GY Z WELL4 ,) S M* PRESS & ATT5;N GIV5 6! "R TO DIE1 EU?ANASIA1 CESS,N ( M$ICAL PROCE- DURES1 & RELAT$ ISSUES1 "O V IMPORTANT FACT HAS BE5 OBSCUR$4 ,_M P WANT E M$I- C,Y R1SONA# ME?OD1 H]OIC OR N1 P]=M$1 & Y MAY 2 "O (! _M4 ,IF1 = EXAMPLE1 "! IS A BR1K"? M$ICAL DEVELOP;T 9 ! W+S T MAY H A DRAMATIC IMPACT ON YR *RONIC ILL;S1 Y MAY WANT E M1SURE TAK5 S T Y >E / >.D IF & :5 ! BR1K"? MAT]IALIZES4 ,Y MAY 2 M ?AN WILL+ 6PURSUE EXP]I;TAL & NEW PROCE- DURES IF !Y C POT5TI,Y REV]SE YR ILL;S4 ,MO/ /&>DIZ$ =MS DON'T #BED EV5 A4RESS ? 2C !Y T5D 6REFLECT ! #AAJ CURR5T BROAD T5D5CY 6PROHIBIT H]OIC MEA- SURES4 ,IF Y D WANT E LIFE-SAV+ PROC$URE & EXTRAORD9>Y M1SURES 7C>DIAC RESUSCITA- ;N1 ME*ANICAL RESPIR,N1 NUTRI;N1 HYDR,N7 P]=M$1 YR LIV+ W %D /ATE ?4 ,IF Y WANT ? ONLY IF "! IS A NEW POT5TIAL TR1T;T = YR 41SE1 !N TAILOR ! LANGUAGE 6REFLECT ?4 ,EXAMPLE3 ,ALZHEIM]'S ,41SE ,! C]TA9TY ( COGNITIVE IMPAIR;T A6ECTS 5D-(-LIFE DECI.NS & SU7E/S MODIFIC,N ( /&>D LANGUAGE & =MS = ^? LIV+ ) ,,AD4 ,LANGUAGE 9 A LIV+ W %D 2 TAILOR$ 6RE- FLECT ! SPECIFIC R1LITIES ( ,,AD4 ,X %D AL 2 TAILOR$ 6A4RESS O!R POT5TIAL ILL;S- ES3 ,IF Y H ,,AD1 Y MAY EV5TU,Y SU3UMB 6O!R ILL;SES 7/ROKE1 PNEUMONIA1 ETC471 N ,,AD4 ,SAMPLE ,/&>D ,PROVI.N 8,IF ,I H AN 9CURA# OR IRREV]SI#1 SEV]E M5TAL OR SEV]E PHYSICAL 3DI;N2 OR AM 9 A /ATE ( P]MAN5T UNCONSCI\S;S OR PROF.D DE;TIA2 OR AM SEV]ELY 9JUR$2 OR #BEE IF ,I H A T]M9AL ILL;S1 Z DEF9$ A#AAJ 2L1 !N NO H]OIC M1SURES % 2 P]=M$4 ,= PURPOSES (! ABV1 8T]M9AL ILL;S0 % 2 DE- F9$ Z AN IRREV]SI#1 9CURA#1 & UNTR1TA# 3DI;N CAUS$ 041SE1 ILL;S1 OR 9JURY :5 AN ATT5D+ PHYSICIAN C C]TIFY 9 WRIT+ T1 6A R1SONA# DEGREE ( M$ICAL C]TA9TY1 "! IS NO HOPE ( MY RECOV]Y OR D1? IS LIKELY TO O3UR 9 A BRIEF P]IOD ( "T IF LIFE-SU/A9+ TR1T;T IS N PROVID$4 ,9 ^! SITU,NS ,I WI% T NO H]OIC M1SURES 2 TAK5 6PRES]VE OR PROL;G MY LIFE '''0 ,2L1 ? PROVI.N HAS BE5 REVIS$ 6REFLECT ! R1L;Y ( ,,AD4 ,SAMPLE ,ALZHEIM]'S ,41SE ,MODIFI$ ,PROVI.N 8,I H ,ALZHEIM]'S 41SE1 : IS 9CURA# & IRREV]SI# & : W RESULT 9 DE;TIA4 ,"!=E1 :5 ,I R1* A /AGE ( PROF.D ,ALZHEIM]'S 41SE :5 ,I H A NE>LY -PLETE OR A -PLETE LACK ( AW>E;S ( MY SURR.D+S1 ,I WI% T NO H]OIC M1SURES 2 TAK5 6PRES]VE MY LIFE4 ,IF ,I R1* A /AGE ( SEV]E #BEF ,ALZHEIM]'S M>K$ 04ORI5T,N PSY*O- #AAA SIS1 DELU.NS1 P>ANOIA1 &_/OR HALLUC9,NS1 & AL AM SEV]ELY 9JUR$1 OR H A T]M9AL ILL;S 7= PURPOSES (! ABV1 8T]M9AL ILL;S0 % 2 DEF9$ Z AN IRREV]SI#1 9CURA#1 & UN- TR1TA# 3DI;N CAUS$ 041SE1 ILL;S1 OR IN- JURY :5 AN ATT5D+ PHYSICIAN C C]TIFY 9 WRIT+ T1 6A R1SONA# DEGREE ( M$ICAL C]- TA9TY1 "! IS NO HOPE ( MY RECOV]Y OR D1? IS LIKELY 6O3UR 9 A BRIEF P]IOD ( "T1 DEF9$ Z #IJ "DS1 IF LIFE-SU/A9+ TR1T;T IS N PROVID$71 !N ,I WI% T NO H]OIC MEA- SURES 2 TAK5 6PRES]VE MY LIFE4 ,FUR!R1 IF ,I AM !N 9 A /ATE ( SEV]E DE;TIA1 ! #IJ-"D P]IOD ABV %D 2 EXT5D$ 6"O YE>4 ,NOT)/&+ ! =GO+1 IF A NEW TR1T;T IS AVAILA# T CD POT5TI,Y REV]SE MY ,,AD & POT5TI,Y RE/ORE "S R1SONA# QUAL;Y ( LIFE & COGNITIVE ABIL;Y S* T ,I CD 3CEIVABLY -MUNICATE ) MY LOV$ "OS1 !N ALL H]OIC M1SURES % 2 TAK51 9CLUD+ B N LIMIT$ 6! PROVI.N (! NEW OR EXP]I;TAL !RAPY4 ,9 NO EV5T % ANY ,AG5T OR M$ICAL PROVID] MAK+ ? DECI.N 2 HELD LIA# = _! 9T]PRET,N ( ? PROVI.N40 #BEG ,NUTRI;N & ,HYDR,N A#AAA ,Y %D SPECIFIC,Y /ATE :E!R Y WD P]MIT YR AG5T 6"E )DRAW >TIFICIAL NUTRI;N & HY- DR,N4 ,IF Y D N WI% 6H >TIFICIAL FE$+1 EV5 IF 4CONT9U+ X CD HA/5 YR D1?1 ? %D 2 SPECIFIC,Y /AT$4 ,_M /ATES W N P]MIT ! CESS,N ( NUTRI;N OR HYDR,N UN.S ! PA- TI5T'S LIV+ W SPECIFIC,Y AU?ORIZES X4 ,2C "S /ATES REQUIRE A SEP>ATE SIGNATURE 7NEXT 6! PROVI.N7 9 ANY H1L? C>E PROXY T P]MITS AN AG5T 6)DRAW NUTRI;N OR HYDR,N1 X MAY 2 A GD IDEA 6SIGN ? PROVI.N J TO MAKE SURE YR WI%ES >E N IGNOR$ 2C (A TE*NICAL;Y4 ,S"EAL A4I;NAL ISSUES C CR1TE 3FU.N4 ,H[1 = EXAMPLE1 %D 8>TIFICIAL0 2 DEF9$8 ,%D A 4T9C;N 2 MADE 2T )DRAW+ NUTRI;N & HYDR,N 7E4G41 A FE$+ TUBE7 & )HOLD+ ! 9ITIAL 3NEC;N 6>TIFICIAL FE$+ TUBES8 ,D YR RELIGI\S 2LIEFS A6ECT ? DECI.N8 ,! CORE 2LIEFS ( _M RELIGIONS EQUATE ! )- DRAWAL1 & 9 "S CASES ! )HOLD+ 7OR NON- PROVI.N71 ( NUTRI;N & HYDR,N Z ! EQUIVA- L5T ( />V+ "S"O 6D1?4 ,= ? R1SON1 Y M/ 3SID] ! RELIGI\S S5SITIVITIES (! #BEH P Y DESIGNATE Z YR H1L? B#AAA ------------------------------------#AAB C>E AG5TS4 ,IF "S"O Y WANT 6"N AG5T WD H 6VIOLATE 8 OR H] FUNDA;TAL RELIGI\S BE- LIEFS 6C>RY \ YR WI%ES1 D1L ) ? ISSUE N[4 ,DEP5D+ ON YR REL,N%IP ) ? 9DIVIDUAL & YR [N RELIGI\S OR MORAL 3VIC;NS1 Y MAY DECIDE 6MODIFY YR WI%ES1 "N A DI6]5T AG5T1 OR GET CL>IFIC,N F A RELIGI\S AU- ?OR;Y 2F F9ALIZ+ YR DECI.N4 ,QUAL;Y-(-,LIFE ,/ATE;TS ,YR LIV+ W MAY 2 ! ONLY WRITT5 EVID;E ( :AT YR DEEPE/ P]SONAL WI%ES >E4 ,"!=E1 X %D Z CLE>LY & Z PRECISELY Z POSSI# /ATE YR FEEL+S & WI%ES AB H1L? C>E1 TR1T;T1 QUAL;Y ( LIFE1 :E!R Y MAY WI% 6REFUSE OR A3EPT M$ICAL TR1T;T1 & S =?4 ,! LAW MAY REQUIRE T ! LIV+ W DEMON/RATE YR 9T5T ) 8CLE> & 3V9C+ EVID;E40 ,? APPLIES 9 P>- TICUL>LY SIGNIFICANT WAYS 6QUAL;Y-(-LIFE ISSUES4 ,_M LIV+ WILLS 3TA9 G5]AL LAN- GUAGE /AT+ T IF "! IS 8NO QUAL;Y ( LIFE10 !N 8NO H]OIC M1SURES0 %D 2 TAK5 6PROL;G LIFE4 ,B 8NO QUAL;Y ( #BEI LIFE0 M1NS DI6]5T ?+S 6DI6]5T P4 A#AAB ,= "O P]SON1 X MIE1 0DEF9I;N1 L;G-T]M ILL;SES1 S T Y H "S "U/&+ ( :AT YR FUTURE HOLDS4 ,MAKE SPECIFIC QUAL;Y-(-LIFE DECI.NS T "W = Y4 ,=A "Y A?LETIC P]SON ^: BI7E/ H1L? ISSUE HAS BE5 A HANGNAIL1 ! ?"\ ( 2+ 3F9$ 6A :EEL*AIR MAY APPE> S TRAUMAT- IC T HE OR %E MIILY1 X MAY 2 A *OICE T C 2 LIV$ )1 "PICUL>LY Z X P]MITS ! IN- DIVIDUAL 65GAGE 9 NORMAL ACTIVITIES1 AL- 2IT 9 A DI6]5T MODE4 ,= Y1 ! DEF9I;N ( QUAL;Y ( LIFE W DI6] F T PRES5T$ #BFJ 9 EI ( ^! EXAMPLES4 ,X IS1 9 E B#AAB CASE1 A P]SONAL DECI.N T REFLECTS N ONLY PHYSICAL & M5TAL *ANGE B AL P]SONAL BE- LIEFS & NUM]\S O!R FACTORS T DEF9E :O Y >E4 ,ANALYZE YR [N FEEL+S & 3C]NS AB QUAL;Y ( LIFE & MAKE YR WI%ES EXPLICIT4 ------------------------------------#AAC ,GU>DIAN ,DESIGN,N ,IF YR ILL;S W 7OR MAY7 RESULT 9 YR EV5- TUAL 9ABIL;Y 6MANAGE YR A6AIRS & P]SON 6! EXT5T T A GU>DIAN M/ 2 APPO9T$1 3SID] TAK+ ! FOLL[+ TWO /EPS4 ,F/1 A4RESS ALL ! PLANN+ ISSUES & DOCU;TS PRES5T$ 9 ? BOOK1 ESPECI,Y FOCUS+ ON A FUND$ REVOCA# LIV+ TRU/4 ,! SECOND /EP IS 69CLUDE AN EXPRESS PROVI.N 9 YR H1L? PROXY NAM+ YR H1L? PROXY Z YR GU>DIAN4 ,BO? /EPS C PREV5T ! NE$ =A C\RT APPO9T$ GU>DIAN4 ,"! >E1 G5],Y SP1K+1 TWO TYPES ( GU>D- IANS4 ,A GU>DIAN ( YR P]SON MAKES H1L? & LIV+ DECI.NS1 &A GU>DIAN ( YR PROP]TY PRIM>ILY MAKES F9ANCIAL DECI.NS4 ,IDE,Y1 Y %D *OOSE :O W 2 MAK+ ^! DECI.NS ON YR 2HALF4 ,AT A M9IMUM1 Y %D DESIGNATE YR H1L? C>E AG5T Z BO? OR AT L1/ ! #BFA GU>DIAN ( YR P]SON4 ,! OBJECTIVE A#AAC "H IS 6MAKE YR WI%ES "KN 2F GU>DIAN%IP 2COMES AN ISSUE4 ,9 ! EV5T A C\RT 9 ! FUTURE HAS 6APPO9T A GU>DIAN1 Y H MADE "KN YR WI%ES AB :OM T P]SON %D BE4 ,:ILE "! IS NO GU>ANTEE T ! C\RT W FOLL[ YR WI%ES1 SIGNIFICANT WEIE PROXY IS NOT>IZ$ & HAS TWO WIT;SES74 ,SAMPLE ,PROVI.N 8,6! EXT5T T ,I AM P]MITT$ 0LAW 6D S1 ,I "HBY NOM9ATE MY ,AG5T1 .,F9ANCIAL .,AG5T .,"N1 6S]VE Z ! GU>DIAN ( MY PROP]TY1 & MY ,H1L? ,PROXY1 .,H1L? .,AG5T .,"N1 TO S]VE Z ! GU>DIAN ( MY P]SON1 OR 9 ANY SIMIL> REPRES5TATIVE CAPAC;Y1 & IF ,I AM N P]MITT$ 0LAW 6S NOM9ATE1 !N ,I REQUE/ T ANY C\RT T MAY 2 9VOLV$ 9 ! APPO9T;T ( A GU>DIAN1 SPECIAL M$ICAL GU>DIAN1 3S]- VATOR OR SIMIL> REPRES5TATIVE = ME GIVE ! GRTE/ WEIE;LLY GIVE ?"\ 6DONAT+ YR ORGANS AF YR D1?4 ,IF1 H["E1 Y D N WI% 6P]MIT OR- GAN DON,N1 Y %D 9DICATE S 9 YR LIV+ W4 ------------------------------------#AAD ,_M P ]RONE\SLY ASSUME T ORGAN DON,NS >E PROHIBIT$ = RELIGI\S R1SONS4 ,(T5 !Y >E N4 ,D N 4MISS ORGAN DON,NS = RELIGI\S R1SONS AL"O UN.S Y H 3SULT$ YR RELIGI\S ADVIS]4 ,IF ! IDEA ( DONAT+ YR ORGANS TO /RANG]S IS 4TA/E;L 6Y1 3SID] RE/RICT+ ! PROVI.N R ?AN ELIM9AT+ X ALT4 ,= EXAM- PLE1 WD Y REFUSE 6DONATE AN ORGAN OR OR- GANS T MI* 6HELP O!RS )! SAME *RONIC ILL;S Y H4 ,! LANGUAGE %D 2 SPECIFIC 5 65SURE T ! TISSUES W 2 US$ = RESE>* OR = :AT"E SPECIFIC GOAL Y H 9 M9D4 ,EV5 IF Y H A G5]AL RELIGI\S PREF];E AG/ ORGAN DON,NS1 Y MAY WANT 6MAKE ? AN EXCEP;N4 ,IF S1 !N CLE>LY /ATE T AL? YR /AT$ RELIGI\S PREF- ];ES %D APPLY 6ALL O!R DECI.NS1 Y #BFC H EXPRESSLY EXCLUD$ ! APPLIC,N ( A#AAD ^? RELIGI\S /RICTURES 6! DON,N ( TISSUE = RESE>*4 ,Y C MAKE A GRT DI6];E ) ? SIMPLE /EP4 ,SAMPLE ,PROVI.N 8,2C ,I H LIV$ = _M DECADES ) MULTIPLE SCL]OSIS1 ,I EXPRESSLY 9CLUDE ? PROVI.N DIRECT+ ! DON,N ( BRA9 OR C5TRAL N]V\S SY/EM TISSUE SAMPLES = ,,MS RESE>* EF- =TS1 B = NO O!R PURPOSE4 ,I EXPRESSLY NOTE & AC"KL$GE T MY CORE RELIGI\S PREF- ];ES MAY M&ATE AG/ ORGAN DON,NS4 ,N"E!- .S1 ,I EXPRESSLY WI% 6PROVIDE = ^! TIS- SUE DON,NS 9 SPITE ( ANY S* /RICTURES40 ,BURIAL ,9/RUC;NS ,IF Y DESIRE ANY SPECIFIC EULOGY1 S]- VICE1 OR /EPS TAK51 SPECIFY YR WI%ES 9 YR LIV+ W4 ,IF Y WANT A TRADI;NAL RELI- GI\S C]EMONY1 SAY S4 ,IF Y WANT 6BE CRE- MAT$ R ?AN BURI$1 SAY S4 ,ALT]NATIVELY1 Y C -MUNICATE ^! & O!R DESIRES 9 A LR ( LA/ 9/RUC;NS4 #BFD ,RELIGION B#AAD ,RELIGI\S PREF];ES OR LACK "!( %D 2 SPECIFI$4 ,= ^? ) /R;G RELIGI\S 3VIC;NS1 X IS IMP]ATIVE 6SPECIFIC,Y A4RESS RELI- GI\S ------------------------------------#AAE 3C]NS 6AVOID HAV+ YR 2LIEFS -PROMIS$ :5 Y MAY 2 UNA# 6EXPRESS YR DESIRES4 ,S9CE H1L? C>E WI%ES >E S* A P]SONAL MATT]1 X IS AL VITAL 6A4RESS RELIGI\S 3C]NS 6PRE- V5T FAMILY MEMB]S OR O!RS 9VOLV$ ) YR H1L? C>E F PU%+ _! 2LIEFS 7OR LACK ( BE- LIEFS7 ON Y4 ,= EXAMPLE1 IF Y >E ,CA?O- LIC & WI% 6H LA/ RITES1 YR LIV+ W %D S /ATE4 ,! LEGAL -MUN;Y1 "R-TO-DIE ORGANIZ,NS1 & _M O!RS 9VOLV$ )! H1L? C>E DECI.N PROCESS H ALL B IGNOR$ RELIGI\S 3SID],NS ASSUM+ T MO/ P SIGN+ LIV+ WILLS :ILE !Y >E H1L?Y >5'T 3C]N$ AB RELIGI\S ISSUES4 ,^! ORGANIZ,NS1 H["E1 FAIL 6-PREH5D T _M ( ^! SAME P1 :5 FAC$ )A MAJOR CATA/ROPHE S* Z T]M9AL ILL;S OR LOSS (A CLOSE FAMI- LY MEMB]1 FALL BACK ON _! RELIGI\S ROOTS = GUID.E & -=T4 ,UN=TUNATELY1 9 ! #BFE CASE ( *RONIC ILL;SES T EV5TU,Y A#AAE L1D 6COGNITIVE IMPAIR;T1 X MAY !N 2 TOO LATE = ^! P OR _! LOV$ "OS 6EXPRESS _SU- AL *ANGES4 ,! SOLU;N IS 6?9K AB ? ISSUE &! RELIGI\S IMPLIC,NS (! 5TIRE H1L? C>E PROCESS :ILE Y >E A# TO4 ,9 ! 5D1 "! W 2 NO REGRETS T "S?+ IMPORTANT 0 N A4RESS$4 7,= M DETAIL ON RELIGION & XS POT5TIAL IMPACT ON E/ATE PLANN+1 SEE ,*APT] #AB47 ,:E!R OR N Y H ANY RELIGI\S 3VIC;NS1 YR LIV+ W %D -MUNICATE YR DECI.NS4 ,IF Y 7 BORN 6P>5TS )A "PICUL> RELIGI\S A6ILI- ,N1 O!R MEMB]S ( YR FAMILY CD ASSUME T X WD 2 APPROPRIATE 63SULT ) CL]GY ( YR RE- LIGI\S BACKGR.D 2F MAK+ A DECI.N4 ,? MAY OR MAY N 2 :AT Y WI% 6H D"O4 ,RELIGI\SLY 9FLU;ED DECI.NS C WELL 2 DI6]5T F :AT Y WANT4 ,= EXAMPLE1 S"EAL RELIGIONS RE- /RICT ! ABIL;Y 6/OP H]OIC M1SURES4 ,IF Y WANT NUTRI;N & HYDR,N )DRAWN IF "! IS NO HOPE ( YR REGA9+ QUAL;Y ( LIFE1 X IS IM- PORTANT 6-MUNICATE :E!R Y WI% RELIGI\S PR9CIPLES 6BE 3SID]$ 9 MAK+ ? DECI.N4 ,RELIGI\S DOCTR9ES MAY H A V SPECIFIC E6ECT ON :AT C 2 D"O M$IC,Y TO #BFF SU/A9 OR N SU/A9 LIFE4 ,H["E Y B#AAE PRES5TLY FEEL AB ! E6ECTS ! T5ETS ( YR FAI? MAY H ON ^! DECI.NS1 X C 2 A T]RI# MISTAKE N 6A4RESS ^! ISSUES ) YR CL]GY4 ,YR FAMILY'S RELIGI\S 3VIC;NS %D AL 2 3SID]$4 ,) "S MODIFIC,N1 X MAY 2 POSSI# 6C>RY \ YR WI%ES 9 A MANN] T DOES N NE- GATE ! RELIGI\S T5ETS ( YR FAI?4 ,IF Y DECIDE1 AF 3SULT+ ) YR CL]GY & 4CUS.NS ) YR FAMILY1 T Y WI% 6TAKE A PO- SI;N 3TR>Y 6! T5ETS ( YR ------------------------------------#AAF FAI? 7E4G41 = TISSUE DON,NS Z 4CUSS$ ABV71 YR LIV+ W %D 9DICATE ? 9 V PRECISE T]MS4 ,Y MAY WI% 6PROVIDE ! "N & A4RESS (A CL]GY MEMB] 6YR ATTORNEY S T ! CL]GY MEMB] C 2 3SULT$ = 9T]PRET,NS ( YR RELI- GI\S 2LIEFS4 ,Y %D 9CLUDE 9 A NOTE ( IN- /RUC;N1 & 9 "S 9/.ES EV5 9 YR LEGAL DOC- U;TS1 ! "N (! RELIGI\S ADVIS] 6BE 3TACT$ IF A DECI.N HAS 6BE MADE 3C]N+ YR C>E &! DECI.N _C 2 EASILY MADE )\T RELIGI\S IN- T]PRET,N4 ,AL1 Y %D 9CLUDE ! "N & 3TACT DATA =! RELIGI\S ORGANIZ,N OR 9/ITU;N TO 2 3TACT$ %D ! CL]GY MEMB] Y "ND 2 #BFG UNAVAILA#4 ,X IS Q IMPORTANT T Y A#AAF 4CUSS ^! MATT]S ) YR P]SONAL RELIGI\S ADVIS] 2F Y MEET ) YR LAWY]4 ,PA9 ,RELIEF ,:AT AB PA9 M$IC,N & O!R TR1T;TS OR PRO- C$URES 6REDUCE PA98 ,%D !Y 2 ADM9I/]$ EV5 IF !Y HA/5 D1?8 ,IS "! ANY ADV]SE RELIGI\S IMPLIC,NS IF PA9 RELIEF HA/5S D1?8 ,%D A 4T9C;N 2 MADE 2T ! SIDE EF- FECTS ( PA9 RELIEF "S:AT HA/5+ D1? V]SUS A6IRMATIVELY US+ PA9 M$IC,N 9 DOSES IN- T5D$ 6CAUSE D1?8 ,H[ C ? 4T9C;N 2 MADE8 ,>E "! ANY SPECIFIC IMPLIC,NS ( YR ILL;S T MAY E6ECT H[ Y WANT 6M&ATE PA9 RELIEF8 ,YR ANSW]S 6^! & SIMIL> "QS %D 2COME "P ( YR LIV+ W4 ,W ,AMBUL.E & ,EM]G5CY ,M$ICAL ,TE*NICIANS ,A3EPT ,LIV+ ,W8 ,! PRIM>Y GOAL ( AMBUL.E & EM]G5CY M$I- CAL TE*NICIANS IS SAV+ LIVES1 OR M SPE- CIFIC,Y1 KEEP+ A PATI5T ALIVE UNTIL HE OR %E R1*ES A HOSPITAL4 ,! URG5T #BFH NATURE ( _! ACTIVITIES1 ! "T B#AAF FRAME ( _! 9VOLVE;T1 & _! PRIM>Y MIS.N MAKE X DI6ICULT IF N IMPOSSI# = !M 6RE- VIEW1 9T]PRET1 & !N APPLY ! PROVI.NS ( YR LIV+ W4 ,PLAN 9 ADV.E4 ,IF Y >E T]M9,Y ILL OR AT A /AGE ( DE- ;TIA AT : Y WD N WANT H]OIC M1SURES1 Y MAY PREF] 63SID] ALT]NATIVE TRANSPORT,N >RANGE;TS 6! HOSPITAL 6AVOID HAV+ ! EM]- G5CY P]SONNEL P]=M+ H]OIC M1SURES 9 ! AMBUL.E4 ,4CUSS ? ) YR H1L? C>E AG5TS & DOCTOR 9 ADV.E4 ------------------------------------#AAG ,:AT ,AB ,OLD ,LIV+ ,WILLS8 ,X IS BE/ 6LOCATE & DE/ROY OLD LIV+ WILLS4 ,? IS ESPECI,Y WISE IF YR PRIOR LIV+ W & H1L? PROXY 7 SIGN$ PRIOR 6YR DIAGNOSIS4 ,2+ DIAGNOS$ )A *RONIC ILL;S *ANGES ALM "EY?+1 9CLUD+ H[ Y VIEW ANY FUTURE H1L? C>E ISSUES4 ,MO/ LIKELY1 YR WI%ES & NE$S W H EVOLV$ SIGNIFICANTLY &! MODIFIC,NS W 2 REFLECT$ 9 YR NEW LIV+ W4 ,! DANG] ( KEEP+ OLD LIV+ WILLS IS T !Y MAY 9ADV]T5TLY SURFACE AT ! WR;G #BFI "T 9 ! WR;G PLACE 7OR 9 ! WR;G A#AAG H&S7 & CAUSE UNNEC 3FU.N4 ,6PRECLUDE S* AN EV5T1 MAKE SURE ! APPROPRIATE P H ! NEWE/ LIV+ W Y H SIGN$4 ,Y MIE PROXY 6YR PRIM>Y C>E DOCTOR4 ,GIVE YR 9ITIAL AG5T1 & AT L1/ "O SU3ESSOR AG5T1 AN ORIG9AL4 ,YR ATTORNEY W RETA9 A SIGN$ ORIG9AL = AN EM]G5CY4 ,MO/ IMPORTANTLY1 KEEP AN ORIG9AL AT HOME 9 AN A3ESSI# LO- C,N4 ,O!R ,/EPS ,Y ,%D ,TAKE ,4CUSS ,YR ,DECI.NS ,! PROCESS 0: Y DET]M9E :AT YR LIV+ W %D 3TA9 IS J Z IMPORTANT Z ! DOCU;TS Y SIGN4 ,? PROCESS %D "!=E 9CLUDE #BGJ C&ID 4CUS.NS AB YR FEEL+S ) YR B#AAG FAMILY1 LOV$ "OS1 DOCTOR1 & RELIGI\S AD- VIS] 7IF APPLICA#74 ,ALL ( ^! P MAY 2 9VOLV$ 9 ! DECI.NS 3C]N+ YR H1L? C>E IF Y %D 2COME UNA# 6EXPRESS YR [N WI%ES4 ,!Y _C 2 EXPECT$ 6C>RY \ YR DESIRES )\T "K+ :AT ^? DESIRES >E & H[ Y FEEL AB !M4 ,! M OP5LY Y 4CUSS YR FEEL+S ) FAMILY1 FRS1 & LOV$ "OS1 ! M LIKELY T Y C EASE ! BURD5 ( DECI.N MAK+ !Y FACE4 ,:ILE YR RELIGI\S ADVIS] C ASSI/ YR DOCTORS & FAMILY 9 R1*+ A DECI.N T IS 9 A3ORD.E ------------------------------------#AAH ) APPLICA# RELIGI\S T5ETS & YR P]SONAL 2LIEFS1 AN AW>E;S ( YR FEEL+S C 2 IMPOR- TANT 9 PROP]LY GUID+ YR FAMILY & PHYSI- CIANS4 ,! PROCESS ( -MUNICAT+ YR 2LIEFS & FEEL+S IS A V IMPORTANT /EP2 X _C 2 A3OMPLI%$ 0SIGN+ A QK-FIX =M ) YR LAWY]4 ,COORD9ATE ,YR ,H1L? ,C>E & ,F9AN- CIAL ,DOCU;TS ,A DURA# P[] ( ATTORNEY ) F9ANCIAL P[]S IS AN 9TEGRAL "P ( YR H1L? C>E 7& E/ATE7 PLANN+4 ,IF ! AG5T Y AU?ORIZE #BGA DOES N H ! F9ANCIAL ":)AL1 OR ! A#AAH LEGAL A3ESS 6YR FUNDS 6C>RY \ YR H1L? C>E WI%ES1 !N YR DESIRES CD AL 2 /YMI$4 ,F9ANCIAL 3SID],NS %D 2 A4RESS$ Z A SEP- >ATE DOCU;T S9CE "S /ATES D N P]MIT ! GRANT ( H1L? C>E & F9ANCIAL P[]S 9 ! SAME DOCU;T4 ,? C 2 "PICUL>LY IMPORTANT IF YR ATTITUDE AB ! RELIGI\S IMPLIC,NS ( A LIV+ W OR H1L? C>E PROXY DI6]S F T ( FAMILY MEMB]S4 ,Z AN ALT]NATIVE1 A LIV+ TRU/ 7N 6BE 3FUS$ )A LIV+ W71 : IS AL CALL$ A REVOCA# 9T] VIVOS TRU/1 C 2 US$4 ,:5 PROP]LY PREP>$1 ? DOCU;T C A4RESS A BROAD RANGE ( F9ANCIAL & O!R ISSUES1 IN- CLUD+ ! H&L+ ( YR F9ANCIAL MATT]S 9 ! EV5T ( 4ABIL;Y1 M* M -PREH5SIVELY ?AN A P[] ( ATTORNEY4 ,! LIV+ TRU/ REMA9S A P[];L & FLEXI# F9ANCIAL PLANN+ TOOL = H&L+ YR F9ANCIAL MATT]S 9 ! EV5T ( DIS- ABIL;Y4 ,6MAKE YR P[] ( ATTORNEY OR LIV+ TRU/ E6ECTIVE1 2 C]TA9 T YR ATTORNEY-IN- FACT OR TRU/EES H ADEQUATE F9ANCIAL 9=- M,N 6LOCATE & M>%AL YR ASSETS = YR B5E- FIT4 ,! BE/ LEGAL DOCU;TS >E USE.S IF FAMILY MEMB]S C'T LOCATE YR BANK #BGB OR SECURITIES A3.TS 6APPLY YR B#AAH ASSETS 6MEET YR H1L? C>E WI%ES4 ,C>RY A ,POCKET ,C>D ,:AT"E YR WI%ES 3C]N+ YR H1L? C>E1 PROP- ]LY PREP>$ DOCU;TS >E F> TOO BULKY 6C>RY ON YR P]SON4 ,9 AN EM]G5CY SITU,N1 YR ATT5D+ PHYSICIANS C AT L1/ 2 9=M$ 0A WALLET C>D T Y SIGN$ A LIV+ W & H1L? C>E PROXY1 & :OM 63TACT4 ,X MI A M$ICAL ID5TIFIC,N BRACELET OR O!R ID5TIFY+ DE- VICE4 ------------------------------------#AAI ,3SID] ! ,POLICIES (A ,"PICUL> ,H1L? ,C>E ,FACIL;Y ,IF Y >E GO+ 65T] A NURS+ HOME OR O!R H1L? C>E FACIL;Y1 2 C]TA9 6REVIEW XS POLICIES AB FUNDA;TAL H1L? C>E ISSUES4 ,IF ! ORGANIZ,N'S POLICIES >E 9COMPATI# ) YR H1L? C>E WI%ES1 Y MAY WI% 6EVALUATE ALT]NATIVE FACILITIES4 ,= EXAMPLE1 IF ! FACIL;Y IS SPONSOR$ 0A ,CA?OLIC ORGANI- Z,N1 "! MAY 2 A /RICT POLICY AG/ #BGC ASSI/$ SUICIDE OR EU?ANASIA4 ,? A#AAI POLICY MAY N 2 A6ECT$ NO MATT] :AT IS /AT$ 9 YR LIV+ W4 ,A ,JEWI% H1L? C>E FA- CIL;Y MAY H A POLICY ( ADM9I/]+ NUTRI;N & HYDR,N UN.S M$IC,Y 3TRA9DICAT$4 ,IF Y >E A ,JEHOVAH'S ,WIT;S1 ID5TIFY M$ICAL 9/ITU;NS FAMILI> )& A# 6A4RESS YR SPE- CIAL RELIGI\S_/M$ICAL NE$S4 ,9 "S CASES1 IF Y H *OS5 A "PICUL> C\RSE ( AC;N 9 YR LIV+ W1 Y MAY NE$ 6SELECT ! M$ICAL FA- CIL;Y ) SIMIL> POLICIES AB C>E & ADV.E PLANN+4 ,*APT] ,SUMM>Y 7777777777777777777777777777777777777777 ,? *APT] HAS REVIEW$ TWO KEY H1L? C>E DECI.N DOCU;TS3 YR LIV+ W & H1L? C>E PROXY4 ,^! DOCU;TS >E IMPORTANT 6YR DIG- N;Y Z A HUMAN 2+1 6M9IMIZE EMO;NAL /RESS ON YR LOV$ "OS1 & 65SURE T YR WI%ES >E RESPECT$4 ,? M1NS TAK+ ! "T & EF=T TO CRAFT ^! DOCU;TS 6A4RESS ANY CURR5T "KN H1L? 3DI;NS1 ! LIKELY ISSUES T MAY >ISE 9 ! FUTURE Z A RESULT ( YR *RONIC ILL;S1 #BGD & ANY RELIGI\S 3VIC;NS Y H4 B#AAI GGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGGG #BGE ,,LIV+ ,,W #ABJ ,I1 99 .,YR .,"N1 RESID+ AT 99 .,YR .,A4RESS1 2+ AN ADULT &( S.D M9D1 & 2+ -PET5T & O!RWISE CAPA# ( MAK+ ! DECI.NS SET =? 9 ? ,LIV+ ,W1 & HAV+ ! FUNDA;TAL "R 6MAKE VOLUNT>Y1 9=M$ *OICES 6A3EPT1 REJECT1 OR *OOSE AM;G ALT]NATIVE C\RSES ( M$ICAL & SURGICAL TR1T;T1 MAKE ? DEC- L>,N Z A DIRECTIVE 6BE FOLL[$ IF = ANY R1SON ,I 2COME UNA# 6"PICIPATE 9 DECI.NS REG>D+ MY M$ICAL C>E1 ? /ATE;T % /& Z AN EXPRES.N ( MY WI%ES1 2LIEFS1 OBJECTIVES & DIREC;NS 7MY 8,WI%ES074 ,X IS MY SPE- CIFIC 9T5T T MY ,WI%ES1 Z /AT$ "H9 3/I- TUTE CLE> & 3V9C+ EVID;E ( S* ,WI%ES4 #A4 ,RECITALS4 A4 .,":=E1 ,I DIRECT T ? ,LIV+ ,W BE- -E A "P ( MY P]MAN5T M$ICAL RECORDS4 ,I EXPRESSLY AU?ORIZE ANY M$ICAL C>E PRO- VID] 6RELY ON ! /ATE;TS 9 ? ,LIV+ ,W IF X IS N F1SI# 9 AN EM]G5CY SITU,N 6R1* MY ,H1L? ,C>E ,AG5T4 ,? ,LIV+ ,W % S]VE Z G5]AL GUID.E = MY ,AG5T APPO9T$ #BGF "U MY SEP>ATE ,H1L? ,C>E ,PROXY A#ABJ OR ,H1L? ,C>E ,P[] ( ,ATTORNEY4 ,H["E1 9 ALL CIRCUM/.ES1 M$ICAL C>E PROVID]S MAY DEF] 6! JUDG;T & 9T]PRET,N ( MY ,H1L? ,C>E ,AG5T (! T]MS ( ? ,LIV+ ,W & % 9 NO EV5T 2 HELD LIA# = RELY+ ON MY ,H1L? ,C>E ,AG5T'S 9T]PRET,NS4 ,I EXPRESSLY RECOGNIZE T X IS IMPOSSI# 63CV ( ALL SITU,NS T MAY O3UR 9 A LIV+ W S T MY ,AG5T MAY A4RESS ALL S* CIRCUM/.ES US+ ! GUIDEL9ES 3TA9$ 9 ? ,LIV+ ,W4 B4 .,":=E1 ,I WI% 6DIRECT ! AC;NS ( MY FAMILY1 FRS1 PHYSICIANS1 NURSES1 & ALL ^? 3C]N$ ) MY C>E1 Z PROVID$ 9 ? DECL>A- ;N4 C4 .,":=E1 ,I "HBY EXPRESS MY HOPE T MY ,WI%ES 2 HONOR$ 0H1L? C>E FACILITIES & PHYSICIANS )\T HAV+ 6G "? ! PROCESS ( ANY JUDICIAL OR O!R DET]M9,N4 .,N[ .,"!=E1 ,I DCL MY WI%ES 6BE Z FOLL[S3 #B4 ,CURR5T1 ,"KN1 OR ,SUSPECT$ ,M$I- CAL ,3DI;NS4 #BGG A4 .,-;T3 ,DESCRIBE ANY CURR5T B#ABJ M$ICAL 3DI;NS & H[ X MAY IMPACT M$ICAL DECI.N MAK+4 #C4 ,NO ,H]OIC ,M$ICAL ,EF=TS4 A4 ,G5]AL ,8,NO ,H]OIC ,M1SURES0' ,LANGUAGE4 7#A7 .,-;T3 .,*RONIC .,ILL;S3 ,Y MAY WANT E M$IC,Y R1SONA# ME?OD1 H]OIC OR N1 P]=M$4 ,IF "! IS A BR1K"? M$ICAL DEVEL- OP;T 9 ! W+S T MAY H A DRAMATIC IMPACT ON YR *RONIC ILL;S1 Y MAY WANT E M1SURE TAK54 ,Y MAY 2 M ?AN WILL+ 6PURSUE EXP]- I;TAL & NEW PROC$URES IF !Y CD POT5TI,Y REV]SE YR ILL;S4 ,MO/ /&>DIZ$ =MS N ONLY DON'T 3TEMPLATE ?1 B WD LIKELY RESULT 9 TR1T+ ^! Z PROHIBIT$ 8H]OIC M1SURES40 ,IF Y WANT E LIFE-SAV+ PROC$URE & EX- TRAORD9>Y M1SURES 7C>DIAC RESUSCIT,N1 ME*ANICAL RESPIR,N1 NUTRI;N1 HYDR,N7 P]- =M$1 YR LIV+ W %D /ATE ?4 ,IF Y ONLY WANT ? IF "! IS A NEW POT5TIAL TR1T;T = YR 41SE1 !N TAILOR ! LANGUAGE 6REFLECT ?4 ,! ILLU/RATIVE PROVI.N 2L = "S"O ) ,ALZHEIM]'S 41SE C PROVIDE GUID.E #BGH Z 6H[ Y C MODIFY ! G5]AL PROVI- C#ABJ .NS LAT] 6REFLECT YR P]SONAL SITU,N4 7#B7 ..,SAMPLE ,ALZHEIM]'S ,41SE ,PRO- VI.N 6,MODIFY = ,V>I\S ,H1L? .,ISSUES3 8,I H ,ALZHEIM]'S 41SE : IS 9CURA# & IR- REV]SI# & : W RESULT 9 DE;TIA4 ,"!=E1 :5 ,I R1* A /AGE ( PROF.D ,ALZHEIM]'S 41SE & ,I H A NE>LY -PLETE OR A -PLETE LACK ( AW>E;S ( MY SURR.D+S1 ,I WI% T NO H]OIC M1SURES 2 TAK5 6PRES]VE MY LIFE4 ,IF ,I R1* A /AGE ( SEV]E ,ALZHEIM]'S M>K$ BY 4ORI5T,N PSY*OSIS1 DELU.NS1 P>ANOIA1 &_/OR HALLUC9,NS1 & AL AM SEV]ELY 9JUR$1 OR H A T]M9AL ILL;S 7,= PURPOSES (! 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PROVI.N40 7#C7 ..,G5]AL ,NO ,H]OIC ,M1SURES .,LANGUAGE4 ,IF3 7A7 ,I H AN 9CURA# OR IRREV]SI#1 SEV]E M5TAL OR SEV]E PHYSICAL 3DI;N2 OR AM 9 A /ATE ( P]MAN5T UNCONSCI\S;S OR PROF.D DE;TIA2 OR AM SEV]ELY 9JUR$1 OR H A T]- M9AL ILL;S 7= PURPOSES (! ABV1 8T]M9AL ILL;S0 % 2 DEF9$ Z AN IRREV]SI#1 9CURA#1 & UNTR1TA# 3DI;N CAUS$ 041SE1 ILL;S1 OR 9JURY :5 AN ATT5D+ PHYSICIAN C C]TIFY 9 WRIT+ T1 6A R1SONA# DEGREE ( M$ICAL C]- TA9TY1 "! IS NO HOPE ( MY RECOV]Y OR D1? IS LIKELY 6O3UR 9 A BRIEF P]IOD ( "T IF LIFE-SU/A9+ TR1T;T IS N PROVID$4 #BHJ 8,P]MAN5TLY UNCONSCI\S0 IS DEF9$ B#ABA Z A /ATE T1 6A R1SONA# DEGREE ( M$ICAL C]TA9TY1 AN ATT5D+ PHYSICIAN C]TIFIES 9 WRIT+ T ,I AM IRREV]SIBLY UNAW>E ( MYF & MY 5VIRON;T & "! IS A TOTAL LOSS ( C]E- BRAL CORTICAL FUNC;N+ RESULT+ 9 MY HAV+ NO CAPAC;Y 6EXP]I;E PA972 & 7B7 ,9 ANY ( ^! CASES "! IS NO R1SONA# EXPECT,N ( RECOV]+ F S* SEV]E1 P]MAN5T 3DI;N1 & REGA9+ ANY M1N+;L QUAL;Y ( LIFE1 !N 9 ANY S* EV5T1 X IS MY DESIRE & 9T5T T H]OIC LIFE-SU/A9+ PROC$URES & EX- TRAORD9>Y MA9T5.E OR M$ICAL TR1T;T 2 )- HELD & )DRAWN4 7C7 ,QUAL;Y ( LIFE IS ( TREM5D\S IM- PORT.E 9 DET]M9+ ! SCOPE & EXT5T ( H1L? C>E S]VICES : ,I WI% 6RCV4 ,MA9TA9+ MY LIFE Z A M]E BIOLOGICAL EXI/;E1 9 A VEG- ETATIVE /ATE1 IS N AN A3EPTA# GOAL ( MY M$ICAL TR1T;T4 ,"!=E1 IF "! IS NO R1SON- A# PROBABIL;Y 7I4E41 NEGLIGI# PROBABILI- TY7 T ANY "PICUL> M$ICAL TR1T;T WD B5E- FIT ME 0RETURN+ ME 6A LEVEL ( FUNC;N+ OR EXI/;E ": ,I CD -MUNICATE ) MY LOV$ "OS1 & R1SONABLY "U/& S* -MUNIC,N1 ,I #BHA DIRECT T M$ICAL TR1T;TS1 Z C#ABA DESCRIB$ "H91 2 )HELD & )DRAWN4 7#A7 .,-;T3 ,%D ! 8QUAL;Y ( LIFE0 PRO- VI.NS 2 MODIFI$8 ,_M LIV+ WILLS 3TA9 G5- ]AL /ATE;TS T IF "! IS 8NO QUAL;Y ( LIFE10 !N 8NO H]OIC M1SURES0 %D 2 TAK5 6PROL;G YR LIFE4 ,NO QUAL;Y ( LIFE MIE L;G T]M S T Y H "S "U/&+ ( :AT YR FUTURE HOLDS4 ,MAKE SPE- CIFIC DECI.NS T "W = Y4 ,=A "Y A?LETIC P]SON ^: BI7E/ H1L? ISSUE HAS BE5 A HANGNAIL1 ! ?"\ ( 2+ 3F9$ 6A :EEL *AIR MAY APPE> S TRAUMATIC T !Y MIILY MADE1 MAY H _H LL IMPACT ON YR P]SONAL & #BHB BUSI;S ACTIVITIES4 ,= Y1 ! DEFI- D#ABA NI;N ( QUAL;Y ( LIFE W DI6] F T (! "Y P]SON ABV4 7D7 ,X IS N MY DESIRE 6PROL;G MY LIFE "? ME*ANICAL M1NS ": MY BODY IS NO L;G] A# 6P]=M VITAL BODILY FUNC;NS ON XS [N1 & ": "! IS LL LIKELIHOOD ( "E REGA9+ ANY M1N+;L QUAL;Y ( LIFE4 ,! 3DI;N & DEGREE ( SEV];Y & P]MAN;E 3TEMPLAT$ 0? PROVI.N >E ( S* A NATURE & DEGREE ( P]MAN5T ILL- ;S1 9JURY1 4ABIL;Y1 OR A3OMPANI$ 0PA9 S* T ! AV]AGE P]SON WD MAKE ! DECI.NS ,I H MADE "H94 7E7 ,9 ANY S* EV5T1 ,I DIRECT ALL PHY- SICIANS & M$ICAL FACILITIES 9 ^: C>E ,I MAY BE1 & MY FAMILY & ALL ^? 3C]N$ ) MY C>E1 6REFRA9 F & C1SE EXTRAORD9>Y OR HE- ROIC LIFE SU/A9+ TR1T;T 6BE )HELD & )- DRAWN 7I4E41 6BE 3SID]$ H]OIC7 9CLUDE1 )\T LIMIT,N1 SURG]Y1 ANTIBIOTICS1 C>DIAC & PULMON>Y RESUSCIT,N1 V5TIL,N1 9TUB,N1 OR O!R RESPIRATORY SUPPORT 7EXCEPT Z PROVID$ O!RWISE ------------------------------------#ABB "U ! PROVI.N 2L ,8,NUTRI;N & #BHC ,HYDR,N0'71 M$ICAL & SURGICAL A#ABB TE/S & TR1T;TS & M$IC,NS DIAGNO/IC TE/S ( ANY NATURE1 & SURGICAL PROC$URES ( ANY NATURE4 #D4 .,NUTRI;N .& .,HYDR,N4 ,IF ANY AT- T5D+ PHYSICIAN % /ATE 9 WRIT+ T ,I AM1 6A R1SONA# DEGREE ( M$ICAL C]TA9TY1 9 A T]M9AL 3DI;N OR A P]MAN5TLY UNCONSCI\S /ATE1 & T ! PROVI.N 7OR 3T9U$ PROVI.N7 ( NUTRI;N & HYDR,N W N1 6A R1SONA# DEGREE ( M$ICAL C]TA9TY1 PROL;G MY LIFE 9 A3OR- D.E ) MY WI%ES1 PROVIDE -=T 6ME1 OR M9I- MIZE MY PA9 OR 4COM=T1 !N ,I AU?ORIZE & DIRECT T ! PROVI.N ( FUR!R NUTRI;N OR HYDR,N MAY C1SE4 ,I AGREE 6ABV NUTRI;N_/HYDR,N PROVI.N3 ---- 99 .,YR .,"N #E4 ..,M$IC,N & ,TR1T;TS 6,ALLEVIATE ,PA9 & .,SU6]+4 A4 ,EV5 IF PROC$URES & TR1T;TS >E 6BE )HELD OR )DRAWN1 ,I WI% T ALL #BHD PALLIATIVE TR1T;T & M1SURES = MY B#ABB -=T1 & 6ALLEVIATE MY PA91 2 3T9U$4 B4 ,S* EF=TS 6RELIEVE PA9 MAY 2 3T9U$ EV5 IF S* M1SURES MAY3 %ORT5 MY LIFE1 L1D 6P]MAN5T A4IC;N1 H POT5TI,Y DANG]\S ANCILL>Y 3SEQU;ES1 R5D] ME UNCONSCI\S1 OR L1D 6P]MAN5T PHYSICAL DAMAGE4 #F4 ..,WI%ES ,3C]N+ ,LIV+ .,>RANGE;TS4 A4 .,-;T3 ,ELABORATE & PROVIDE DETAIL1 4CUSS HOSPICE C>E >RANGE;TS4 B4 ,X IS MY WI% T ,I LIVE 9 MY HOME R ?AN AN 9/ITU;N1 HOSPITAL1 NURS+ HOME1 OR O!R FACIL;Y1 IF S* AN >RANGE;T WD N JEOP>DIZE ! *.E (A M1N+;L RECOV]Y1 IM- POSE UNDUE BURD5 ON MY FAMILY1 OR PREV5T MY OBTA9+ MAXIMUM PA9 RELIEF = ANY ILL;S F : ,I SU6]4 C4 ,AL? ,I H "S PREF];E 6RESIDE 9 MY HOME ) C>E1 IF NO FAMILY MEMB] IS LIV+ ) ME1 & ONLY HIR$ HELP C 2 OBTA9$1 ,I RE- QUE/ T MY ,AG5T1 9 MY ,AG5T'S 4CRE;N1 WEI< ! B5EFITS ( S* AN 5VIRON;T 6T (A BETT] H1L? C>E FACIL;Y1 IF AVAILA#4 ,BY WAY ( EXAMPLE & N LIMIT,N1 ! #BHE S]VICES & SOCIALIZ,N (A H1L? C>E C#ABB FACIL;Y %D 2 3SID]$4 #G4 ..,TRANSF] OR ,REMOVAL 6,ANO!R ,H1L? ,C>E .,FACIL;Y4 A4 ,9 ! EV5T T ANY H1L? C>E FACIL;Y 9 : ,I AM LOCAT$ IS UNWILL+ OR UNA# 6C>RY \ MY ,WI%ES1 ,I AU?ORIZE MY 2+ MOV$ 6AN- O!R H1L? C>E FACIL;Y1 EV5 "O LOCAT$ 9 A DI6]5T /ATE 7& 6FACILITATE S* A REMOVAL ,I EXPRESSLY AU?ORIZE T ! LAWS ( S* O!R /ATE MAY 2 DESIGNAT$ 6GOV]N ? DOCU;T74 ,I DIRECT T MY H1L? C>E PROVID]S COOP]- ATE )1 & ASSI/ IN1 PROMPTLY TRANSF]R+ ME 6ANO!R H1L? C>E FACIL;Y IF NEC = MY C>E OR 6C>RY \ MY ,WI%ES4 B4 ,I FUR!R DIRECT MY M$ICAL C>E PRO- VID] 6TRANSF] A COPY ( ALL ( MY M$ICAL RECORDS ) ME 9 S* 9/.E4 ,? AU?ORIZ,N TO REL1SE M$ICAL RECORDS1 6ANY H1L? C>E FA- CIL;Y 6: ,I AM TRANSF]R$1 IS EXPRESSLY 9T5D$ 63/ITUTE A FULL AU?ORIZ,N & REL1SE "U ,,HIPAA ( ANY S* 9=M,N1 9CLUD+ B N LIMIT$ 6PRIVATE H1L? 9=M,N4 ,I SPECIFI- C,Y 9DEMNIFY & HOLD H>M.S ANY #BHF M$ICAL C>E FACIL;Y REL1S+ ME & D#ABB MY RECORDS = S* PURPOSE4 #H4 ..,C>E;L ,3SID],N ,HAS ,BE5 ,MADE ( ,DECI.NS 9 ,? .,DOCU;T4 A4 ,^! DECI.NS & REQUE/S >E MADE AF C>E;L 3SID],N & REFLEC;N4 B4 ,^! DECI.NS >E MADE 6AVOID ! 9DIG- N;Y1 PA9 & DI6ICULTIES1 BO? = MYF & MY FAMILY1 ( PROL;G$1 HOPE.S DET]IOR,N & DEP5D;E ": ,I AM 9 A 3DI;N DESCRIB$ ABV4 ------------------------------------#ABC #I4 ..,RELIGI\S ,3VIC;NS3 ,G5]AL .,/ATE;T4 A4 .,OP;N .#A3 ..,NO ,RELIGI\S ,RE- /RIC;NS ,%D .,APPLY4 ,I D N WI% 63DI;N ! E6ECTIVE;S ( ? DIRECTIVE ^U XS 3=M+ 6ANY 99 .,RELIGION OR O!R RELIGI\S DOCTR9ES OR 2LIEFS 6: ,I MAY 2 2LIEV$ 6SUBSCRIBE4 B4 .,OP;N .#B3 ..,RELIGI\S ,PR9CIPLES ,% ,APPLY 6! ,9T]PRET,N ( ,? ,LIV+ .,W4 ,I WI% 63DI;N ! E6ECTIVE;S ( ? DIRECTIVE ^U XS 3=M+ TO 99 .,RELIGION DOCTR9ES & 2LIEFS 6: ,I SUBSCRIBE4 ,9 ORD] 6E6ECTU- ATE MY ,WI%ES4 IF ANY "Q >ISES Z #BHG 6! REQUIRE;TS ( MY RELIGI\S BE- A#ABC LIEFS4 ,I DIRECT T ! GUID.E (A RELIGI\S ADVISOR SELECT$ 9 A3ORD.E ) MY /ATE;T ( RELIGI\S 2LIEFS MADE 9 ? P>AGRAPH 2 S"\4 #AJ4 .,ORGAN .,DON,N4 .,-;T3 ,IF Y H A *RONIC OR O!R ILL;S Y MAY WI% 6PROVIDE = A SPECIFIC DON,N ( ORGANS OR TISSUES TO P]MIT RESE>* 6-BAT T H1L? PRO#M4 ,! FOL- L[+ IS AN ILLU/RATIVE CLAUSE T C 2 MODI- FI$ = YR H1L? ISSUES4 ,2C ,I H LIV$ = _M DECADES ) ,MULTIPLE ,SCL]OSIS ,I EX- PRESSLY 9CLUDE ? PROVI.N DIRECT+ ! DON,N ( BRA9 OR C5TRAL N]V\S SY/EM 78,,CNS07 TISSUE SAMPLES = ,,MS RESE>* EF=TS4 B = NO O!R PURPOSE4 ,I EXPRESSLY NOTE & AC- "KL$GE T MY CORE RELIGI\S PREF];ES MAY M&ATE AG/ ORGAN DON,NS1 N"E!.S1 ,I EX- PRESSLY WI% 6PROVIDE = ^! TISSUE DON,NS 9 SPITE ( ANY S* /RICTURES4 #AA4 ..,FUN]AL & ,RELAT$ .,>RANGE;TS4 A4 .,-;T3 ,SELECT1 MODIFY4 OR PROVIDE GUID.E Z 6FUN]AL & O!R LA/ >RANGE;TS4 ,3SID] ! 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