Revocation of Health Care Proxy - Michigan 2026

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name as the Declarant in the designated field at the top of the form.
3. Fill in the date when you executed the original Designation of Patient Advocate. This is crucial for clarity.
4. Indicate which parts of the Designation you wish to revoke by checking the appropriate boxes: all, Part 1, Part 2, Part 3, or Part 4.
5. Complete the date section at the bottom of the form where you are signing this revocation.
6. Sign your name in the Signature of Declarant field and print your name below it for verification.
7. Lastly, provide your address in the specified area to ensure proper identification.

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