佐治亚州医疗事务事先嘱托(GeorgiaAdvanceDirectivefor-WellStar.PDF

佐治亚州医疗事务事先嘱托 (Georgia Advance Directive for Healthcare) 签署人： 出生日期： (正体书写姓名) （月/ 日/年） 本医疗事务事先嘱托分为四部分： 第一部分——医疗事务代理人。当您不能（或不愿）为自己的医疗事务做决定的时候，本部分允许您选择某人替您做医疗事务 决定。您选择的人被称为医疗事务代理人。您还可以委托医疗事务代理人在您身故后为您做以下决定：验尸、器官捐赠、遗体捐 赠和遗体处置。请务必将此事的重要性告知你的医疗事务代理人。 第二部分——治疗方式选择。假如您处于临终状态，或处于永久昏迷状态，这部分允许您说明您的治疗方式选择。只有当您无 法表达自己的治疗方式选择时，第二部分才会生效。在第二部分生效前，将会作出合理和适当的努力和您交流您对治疗方式的选 择。您应该和您的家人及其他关系密切的人谈论一下您的治疗方式选择。 第三部分——监护。需要时，这部分允许您指定一名监护人。 第四部分——有效性和签名。这部分需要您和两名见证人的签名。如果您已经填写本表的任何其他部分，那么您必须填写第四 部分。 Georgia Advance Directive for Health Care By: Date of Birth: (Print Name) (Month/Day/Year) This advance directive for health care has four parts: PART ONE—Health Care Agent. This part allows you to choose someone to make health care decisions for you when you cannot (or do not want to) make health care decisions for yourself. The person you choose is called a health care agent. You may also have your health care agent make decisions for you after your death with respect to an autopsy, organ donation, body donation, and final disposition of your body. You should talk to your health care agent about this important role. PART TWO—Treatment Preferences. This part allows you to state your treatment preferences if you have a terminal condition or if you are in a state of permanent unconsciousness. PART TWO will become effective only if you are unable to communicate your treatment preferences. Reasonable and appropriate efforts will be made to communicate with you about your treatment preferences before PART TW O becomes effective. You should talk to your family and others clo