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Fill and Sign the Psychiatric Advance Directives the Bazelon Center for Form

Fill and Sign the Psychiatric Advance Directives the Bazelon Center for 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 New Mexico Statutes Anotated 24-7A-3, 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: Power of Attorney for Health Care. [ ] Part 2: Instructions for Health Care. [ ] Part 3: 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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