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I, (name) , want to choose how i will be. I authorize my health care surrogate to: I authorize my health care surrogate to: (initials required in blank spaces below.). (initials required in the blank spaces.
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Web health care decisions and to provide, withhold, or withdraw consent on my behalf; The forms included on the. Bc 2934a page 1 of 2 rev. I, (name) , want to choose how i will be.
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Web this health care surrogate designation form will help the healthcare team speak to the person you trust to speak on your behalf. I authorize my health care surrogate to: To apply for public benefits to defray the. (initials required in blank spaces below.).
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Web p a t i e n t. Web designation of health care surrogate. (initials required in the blank spaces. I authorize my health care surrogate to: