NOTES FOR COMPLETION 2 COLUMNS - Health and Social Services
NOTES FOR COMPLETION 2 COLUMNS - Health and Social Services
NOTES FOR COMPLETION 2 COLUMNS - Health and Social Services
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13. SIGNATURES OF PROXIES<br />
(Proxy appointment is not valid unless signed by all the proxies.)<br />
I agree to be the proxy for the maker of this Directive. I underst<strong>and</strong> <strong>and</strong> agree to<br />
take on the responsibilities <strong>and</strong> duties of a proxy under the Care Consent Act.<br />
Proxy 1<br />
Signature<br />
Date<br />
Month/Day/Year<br />
Proxy 2<br />
Signature<br />
Date<br />
Month/Day/Year<br />
Alternate Proxy<br />
Signature<br />
Date<br />
Month/Day/Year<br />
5
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