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Home > Medical Center > Forms > Clinical Care Forms > Clinical Forms > Clinical Forms > VIRGINIA ADVANCE DIRECTIVE FOR HEALTHCARE STANDARD FORM

form 161201 Standard : VIRGINIA ADVANCE DIRECTIVE FOR HEALTHCARE STANDARD FORM

2 page general-use form for admission/clinic. Allows for naming agent (accepting all powers) and providing instructions. Information attached.

File Attachment Downloads

view  |  PDF document icon 161201 STANDARD Advance Directive.pdf — PDF document, 585 KB (599370 bytes)


Clinical Form Request

To request a new revision of a Clinical form visit the HIS website.

 

To order multiple copies:

 

  1. Search for and choose the appropriate document. 
  2. Right click the document PDF
  3. Select “Copy shortcut”
  4. Send an email with the PDF form attached to hospcopy@virginia.edu and include the following information:
    • Your name
    • PTAO
    • Quantity
    • Contact/Delivery information

 

PLEASE INCLUDE SPECIFIC PRINTING INSTRUCTIONS (i.e. multi part form, NCR, etc...) 

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