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111234 Directive Waiver indd 2026
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- Click ‘Get Form’ to open the 111234 Directive Waiver in the editor.
- Begin by entering your name in the designated field where it states 'I, ___________'. This identifies you as the individual waiving the directive.
- Next, specify the date of the procedure in the section labeled 'for procedures performed on __________ [DATE]'. This is crucial for context regarding your waiver.
- Review the terms outlined in the waiver carefully. Ensure you understand that signing this document authorizes medical personnel to initiate resuscitative measures if necessary.
- Sign and date the form at the bottom where indicated. If you are not the patient, please indicate your relationship to them in the provided space.
- Lastly, ensure a witness signs where required, confirming that all parties understand and agree to the terms of this waiver.
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