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Fill and Sign the Sc Advance Directive Jervey Eye Group Form

Fill and Sign the Sc Advance Directive Jervey Eye Group Form

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Open the document and fill out all its fields.
Apply your legally-binding eSignature.
Save and invite other recipients to sign it.

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REVOCATION OF DECLARATION FOR MENTAL HEALTH TREATMENT I, ___________________________________________________________________________, Declarant, executed a Declaration for Mental Health Treatment on the ________ day of ________________________, 20____, stating my desires and wishes regarding various aspects of my mental health care and treatment. Oregon Revised Statutes 127.722 provides that a Declaration for Mental Health Treatment may be revoked in whole or in part at any time by the principal if the principal is not incapable. A revocation is effective when a capable principal communicates the revocation to the attending physician or other provider.I hereby revoke that Declaration for Mental Health Treatment.This is my written revocation of my Declaration for Mental Health Treatment and is provided to all persons to whom I have provided a copy of my Declaration for Mental Health Treatment.DATED this the _________ day of ______________________________, 20____.Signature of Declarant: __________________________________________________________Printed Name of Declarant: _______________________________________________________Address of Declarant: ___________________________________________________________

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