Form of declaration

The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. 11_105_1 - Attachment