AFOVA New Letter 2 of Year 2021

Section 7 – Panorama CV 2 No. 02 / 2021 Page 312 of 332 • If you would like to cancel the document, please cross the entire document and write cancelled and sign. Please inform your nominated person, family, general practitioner and health care provider about cancellation of the document. Nominating someone to make decision for you (Appointing the Surrogate or Health Care Power of Attorney) • Please indicate the name of the Surrogate with whom you have discussed your living will • Please ask the Surrogate to read the complete document before completing this section • The Surrogate has to accept this responsibility preferably by signing the document. • Health care providers cannot be surrogates unless they are related to the patient. Sharing information about your Living Will • Please indicate the name of your general practitioner/hospital physician/hospital and consent for this document to be shared. Declaration, Witnessing and Attestation • Please read all the declaration statements carefully and sign and date the declaration • The document should be witnessed by two persons who are not the surrogate, family member or your healthcare provider. • The document will have to be signed in the presence of the concerned authority as may be specified (currently Judicial Magistrate First Class) who will then attest it. However, this requirement is yet to be verified. Assistance with completing the Living Will. • If you are unable to read or write, then a person who is not the patient advocate, family member or your healthcare provider, can read you out the Living Will information and contents of this form and assist you in completing this form. The person assisting you with this form has to provide their details.