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Fill and Sign the Health Declaration Form

Fill and Sign the Health Declaration Form

How it works

Select the health declaration letter sample and open it.
Fill out the form and add an eSignature.
Save the declaration form sample, print, or email it.

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DECLARATION AS TO MEDICAL OR SURGICAL TREATMENT (CRS 15-18-104.) I, _________________________ , (name of declarant), being of sound mind and at least eighteen years of age, direct that my life shall not be artificially prolonged under the circumstances set forth below and hereby declare that: 1. If at any time my attending physician advanced practice nurse and one other qualified physician or advanced practice nurse certify in writing that: a. I have an injury, disease, or illness which is not curable or reversible and which, in their judgment, is a terminal condition, and b. For a period of seven consecutive days or more, I have been unconscious, comatose, or otherwise incompetent so as to be unable to make or communicate responsible decisions concerning my person, then I direct that, in accordance with Colorado law, life-sustaining procedures shall be withdrawn and withheld pursuant to the terms of this declaration, it being understood that life-sustaining procedures shall not include any medical procedure or intervention for nourishment considered necessary by the attending physician to provide comfort or alleviate pain. However, I may specifically direct, in accordance with Colorado law, that artificial nourishment be withdrawn or withheld pursuant to the terms of this declaration. 2. In the event that the only procedure I am being provided is artificial nourishment, I direct that one of the following actions be taken: _______ (initials of declarant) a. Artificial nourishment shall not be continued when it is the only procedure being provided; or _______ (initials of declarant) b. Artificial nourishment shall be continued for _________ days when it is the only procedure being provided; or _______ (initials of declarant) c. Artificial nourishment shall be continued when it is the only procedure being provided. (Optional) I hereby make an anatomical gift, to be effective upon my death, of: A. _______ Any needed organs/tissues OR B. _______ The following organs/tissues: _____________________________ _____________________________ _____________________________ Donor signature: ___________________________________________ 3. I execute this declaration, as my free and voluntary act, this _____ day of ____________________ , 20 _____ . By___________________________ Declarant The foregoing instrument was signed and declared by _________________________ to be his/her declaration, in the presence of us, who, in his/her presence, in the presence of each other, and at his/her request, have signed our names below as witnesses, and we declare that, at the time of the execution of this instrument, the declarant, according to our best knowledge and belief, was of sound mind and under no constraint or undue influence. We further declare that neither of us is : 1) a physician; 2) the declarant’s physician or an employee of his/her physician; 3)an employee or a patient of the health care facility in which the declarant is a patient; or 4) a beneficiary or creditor of the estate of the declarant . Dated at, Colorado, this _____ day of _____________ , 20 _____ . ___________________________________ ___________________________________ Name Name ___________________________________ ___________________________________ Address Address OPTIONAL STATE OF COLORADO ) ) ss. County of ______________ ) SUBSCRIBED and sworn to before me by _______________ , the declarant, and __________________ and _____________________ , witnesses, as the voluntary act and deed of the declarant this _____ day of ________________ , 20 _____ . My commission expires: _________________________ Notary Public

Helpful hints for completing your ‘Health Declaration’ online

Are you fed up with the complications of handling paperwork? Look no further than airSlate SignNow, the premier eSignature solution for individuals and organizations. Bid farewell to the lengthy process of printing and scanning documents. With airSlate SignNow, you can conveniently finish and sign paperwork online. Utilize the robust tools embedded in this user-friendly and cost-effective platform and transform your approach to document management. Whether you require approval for forms or need to gather signatures, airSlate SignNow manages it all effortlessly, with just a few clicks.

Adhere to this step-by-step manual:

  1. Access your account or register for a complimentary trial with our service.
  2. Click +Create to upload a file from your device, cloud storage, or our template library.
  3. Open your ‘Health Declaration’ in the editor.
  4. Click Me (Fill Out Now) to finalize the form on your end.
  5. Add and allocate fillable fields for additional parties (if necessary).
  6. Continue with the Send Invite settings to seek eSignatures from others.
  7. Download, print your copy, or convert it into a reusable template.

Don’t stress if you need to collaborate with your colleagues on your Health Declaration or send it for notarization—our solution encompasses everything you need to achieve such objectives. Enroll with airSlate SignNow today and elevate your document management to a new level!

Here is a list of the most common customer questions. If you can’t find an answer to your question, please don’t hesitate to reach out to us.

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The best way to complete and sign your medical declaration form

Save time on document management with airSlate SignNow and get your medical declaration form eSigned quickly from anywhere with our fully compliant eSignature tool.

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How to complete and sign documents online

Previously, coping with paperwork required lots of time and effort. But with airSlate SignNow, document management is easy and fast. Our robust and easy-to-use eSignature solution lets you effortlessly complete and electronically sign your health declaration form online from any internet-connected device.

Follow the step-by-step guide to eSign your health declaration form template online:

  • 1.Sign up for a free trial with airSlate SignNow or log in to your account with password credentials or SSO authentication.
  • 2.Click Upload or Create and add a form for eSigning from your device, the cloud, or our form catalogue.
  • 3.Click on the file name to open it in the editor and use the left-side menu to fill out all the blank fields accordingly.
  • 4.Place the My Signature field where you need to approve your form. Type your name, draw, or upload a picture of your handwritten signature.
  • 5.Click Save and Close to accomplish modifying your completed document.

As soon as your health declaration form template is ready, download it to your device, export it to the cloud, or invite other people to eSign it. With airSlate SignNow, the eSigning process only takes a few clicks. Use our robust eSignature tool wherever you are to manage your paperwork effectively!

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How to complete and sign paperwork in Google Chrome

Completing and signing documents is simple with the airSlate SignNow extension for Google Chrome. Adding it to your browser is a quick and effective way to deal with your paperwork online. Sign your health declaration form sample with a legally-binding eSignature in just a few clicks without switching between tools and tabs.

Follow the step-by-step guide to eSign your health declaration form in Google Chrome:

  • 1.Go to the Chrome Web Store, locate the airSlate SignNow extension for Chrome, and add it to your browser.
  • 2.Right-click on the link to a document you need to sign and select Open in airSlate SignNow.
  • 3.Log in to your account with your password or Google/Facebook sign-in buttons. If you don’t have one, you can start a free trial.
  • 4.Utilize the Edit & Sign menu on the left to complete your sample, then drag and drop the My Signature option.
  • 5.Add a picture of your handwritten signature, draw it, or simply type in your full name to eSign.
  • 6.Verify all data is correct and click Save and Close to finish modifying your form.

Now, you can save your health declaration form template to your device or cloud storage, send the copy to other people, or invite them to eSign your form with an email request or a secure Signing Link. The airSlate SignNow extension for Google Chrome enhances your document workflows with minimum time and effort. Start using airSlate SignNow today!

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How to complete and sign forms in Gmail

Every time you receive an email containing the health declaration form for signing, there’s no need to print and scan a document or save and re-upload it to another tool. There’s a much better solution if you use Gmail. Try the airSlate SignNow add-on to promptly eSign any documents right from your inbox.

Follow the step-by-step guidelines to eSign your health declaration form in Gmail:

  • 1.Visit the Google Workplace Marketplace and find a airSlate SignNow add-on for Gmail.
  • 2.Install the program with a related button and grant the tool access to your Google account.
  • 3.Open an email containing an attachment that needs approval and utilize the S key on the right sidebar to launch the add-on.
  • 4.Log in to your airSlate SignNow account. Select Send to Sign to forward the file to other parties for approval or click Upload to open it in the editor.
  • 5.Place the My Signature field where you need to eSign: type, draw, or upload your signature.

This eSigning process saves efforts and only takes a couple of clicks. Utilize the airSlate SignNow add-on for Gmail to adjust your health declaration form with fillable fields, sign forms legally, and invite other individuals to eSign them al without leaving your inbox. Boost your signature workflows now!

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How to fill out and sign forms in a mobile browser

Need to quickly complete and sign your health declaration form on a mobile phone while working on the go? airSlate SignNow can help without the need to set up additional software apps. Open our airSlate SignNow tool from any browser on your mobile device and create legally-binding eSignatures on the go, 24/7.

Follow the step-by-step guidelines to eSign your health declaration form in a browser:

  • 1.Open any browser on your device and follow the link www.signnow.com
  • 2.Register for an account with a free trial or log in with your password credentials or SSO option.
  • 3.Click Upload or Create and pick a file that needs to be completed from a cloud, your device, or our form catalogue with ready-to go templates.
  • 4.Open the form and fill out the empty fields with tools from Edit & Sign menu on the left.
  • 5.Place the My Signature field to the form, then type in your name, draw, or upload your signature.

In a few easy clicks, your health declaration form is completed from wherever you are. When you're done with editing, you can save the document on your device, generate a reusable template for it, email it to other individuals, or ask them to eSign it. Make your documents on the go quick and efficient with airSlate SignNow!

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How to complete and sign forms on iOS

In today’s business world, tasks must be completed quickly even when you’re away from your computer. With the airSlate SignNow app, you can organize your paperwork and sign your health declaration form with a legally-binding eSignature right on your iPhone or iPad. Install it on your device to close deals and manage forms from just about anywhere 24/7.

Follow the step-by-step guide to eSign your health declaration form on iOS devices:

  • 1.Go to the App Store, search for the airSlate SignNow app by airSlate, and install it on your device.
  • 2.Open the application, tap Create to import a template, and choose Myself.
  • 3.Choose Signature at the bottom toolbar and simply draw your signature with a finger or stylus to eSign the sample.
  • 4.Tap Done -> Save after signing the sample.
  • 5.Tap Save or take advantage of the Make Template option to re-use this document later on.

This process is so straightforward your health declaration form is completed and signed in a few taps. The airSlate SignNow app works in the cloud so all the forms on your mobile device remain in your account and are available whenever you need them. Use airSlate SignNow for iOS to improve your document management and eSignature workflows!

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How to complete and sign forms on Android

With airSlate SignNow, it’s easy to sign your health declaration form on the go. Set up its mobile app for Android OS on your device and start enhancing eSignature workflows right on your smartphone or tablet.

Follow the step-by-step guidelines to eSign your health declaration form on Android:

  • 1.Navigate to Google Play, search for the airSlate SignNow application from airSlate, and install it on your device.
  • 2.Log in to your account or create it with a free trial, then import a file with a ➕ key on the bottom of you screen.
  • 3.Tap on the imported document and select Open in Editor from the dropdown menu.
  • 4.Tap on Tools tab -> Signature, then draw or type your name to eSign the form. Fill out empty fields with other tools on the bottom if needed.
  • 5.Utilize the ✔ button, then tap on the Save option to finish editing.

With an intuitive interface and full compliance with main eSignature requirements, the airSlate SignNow app is the perfect tool for signing your health declaration form. It even operates without internet and updates all record changes when your internet connection is restored and the tool is synced. Fill out and eSign documents, send them for eSigning, and generate re-usable templates whenever you need and from anyplace with airSlate SignNow.

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