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Fill and Sign the Advance Health Care Directive of Delaware Health and Social Form

Fill and Sign the Advance Health Care Directive of Delaware Health and Social Form

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REVOCATION OF ADVANCE HEALTH CARE DIRECTIVE I, _____________________, Declarant, having executed an Advance Health-Care Directive on the ________ day of ________________, 20____, regarding my decisions and choices concerning my health care. Pursuant to Alaska Statutes § 13.52.020, which provides that an Advance Health Care Directive may be revoked at any time by (1) a signed writing or (2) by personally informing the supervising health care provider of an intent to revoke, I hereby revoke all or those parts of that Advance Health-Care Directive as indicated below: [ ] All of the Advanced Health Care Directive. [ ] Part 1: Durable Power of Attorney for Health Care Decisions.[ ] Part 2: Instructions for Health Care.[ ] Part 3: Anatomical Gift at Death.[ ] Part 4: Mental Health Treatment.[ ] Part 5: Primary Physician. This is my written revocation as indicated above of my Advance Health-Care Directive and is provided to all persons to whom I have provided a copy of my Advance Directive.DATED this the _______ day of __________________, 20____.Signature of Declarant: _________________________________Printed Name of Declarant: ______________________________Address of Declarant: ____________________________________________________

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