Designation of Patient Advocate Form - MidMichigan Health - midmichigan 2025

1. Click ‘Get Form’ to open it in the editor.
2. Begin by entering your name and date of birth at the top of the form. This personal information is crucial for identifying your document.
3. Designate your Patient Advocate by filling in their name, address, and telephone numbers. Ensure this person understands your healthcare wishes.
4. If applicable, appoint one or more successor Patient Advocates. Fill in their details as you did for the primary advocate.
5. In the instructions section, specify any general or specific healthcare instructions you wish to communicate. You can cross out any instructions you do not want.
6. Review the life-sustaining treatment options provided and select one that aligns with your wishes by signing next to your choice.
7. Finally, sign and date the document in front of two witnesses who meet the specified criteria to validate your form.

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