Home
Forms Library
Revocation of Directive to Physicians and Providers of Medical Services - for Persons Signing Instrument on Behalf of Declarant - Utah

Revocation of Directive to Physicians and Providers of Medical Services - for Persons Signing Instrument on Behalf of Declarant - Utah 2025

Revocation of Directive to Physicians and Providers of Medical Services - for Persons Signing Instrument on Behalf of Declarant - Utah Preview on Page 1

See details

4.2 out of 5

47 votes

The document is a formal revocation of a previously executed Directive to Physicians and Providers of Medical Services, as permitted by Utah Code 75-2-1111. It outlines the methods by which the directive can be revoked, including destruction of the document, written revocation, or oral expression in front of a witness. The declarant provides their signature and personal information to confirm the revocation.

Here's how it works

01. Edit your form online

Type text, add images, blackout confidential details, add comments, highlights and more.

02. Sign it in a few clicks

Draw your signature, type it, upload its image, or use your mobile device as a signature pad.

03. Share your form with others

Send it via email, link, or fax. You can also download it, export it or print it out.

How to use or fill out Revocation of Directive to Physicians and Providers of Medical Services - for Persons Signing Instrument on Behalf of Declarant - Utah with DocHub

Ease of Setup

DocHub User Ratings on G2

Ease of Use

DocHub User Ratings on G2

Click ‘Get Form’ to open it in the editor.
Begin by entering your name as the Declarant in the designated field. This identifies you as the individual revoking the directive.
Fill in the date when you originally executed the Directive to Physicians and Providers of Medical Services. This is crucial for record-keeping.
In the next section, indicate any person signing on your behalf, if applicable. This ensures clarity regarding authority.
Review the options provided for revocation. You can choose to obliterate, burn, or deface a copy of the directive, or simply provide this written revocation.
Sign and date the document at the bottom. Ensure that your signature matches your printed name for authenticity.
Finally, distribute copies of this revocation to all concerned parties to ensure they are informed of your decision.

Start using our platform today to easily complete and manage your important documents online for free!

be ready to get more

Complete this form in 5 minutes or less

Get form

Got questions?

We have answers to the most popular questions from our customers. If you can't find an answer to your question, please contact us.

What is the legal document for proxy?

The document that grants an individual the authority to act as a proxy is commonly referred to as the proxy document. This legal document outlines the specific powers and responsibilities bestowed upon the proxy. It serves as proof of the proxys authorization and ensures that their actions are legally binding.

Which document allows someone to designate another person to make healthcare decisions on their behalf?

A POWER OF ATTORNEY FOR HEALTH CARE lets you name an agent to make decisions for you. Your agent can make most medical decisions not just those about life sustaining treatment when you cant speak for yourself. You can also let your agent make decisions earlier, if you wish.

What is the Utah Advance Health Care Directive statute?

(a) An adult may make an advance health care directive in which the adult may: (i) appoint a health care agent or choose not to appoint a health care agent; (ii) give directions for the care of the adult after the adult loses health care decision making capacity; (iii) choose not to give directions; (iv) state

What is the legal document signed by the patient that names an agent or proxy with the authority to make medical decisions on behalf of the patient?

A medical or healthcare power of attorney is a type of advance directive in which you name a person to make healthcare decisions for you when you are unable to do so. In some states this directive also may be called a durable power of attorney for healthcare or a healthcare proxy.