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Designation of Health Care Surrogate

This is a document in which you appoint someone else to make decisions for you regarding your medical care. If your health declines to a state that you are no longer able to communicate with others, the person you list as your health care surrogate will do so for you.

In addition to designating your health care surrogate, this document may also provide advance directions including a complete expression of your preference concerning organ donation as well as the life saving/sustaining measures which you do or do not want. (This information will also appear in your living will.) The surrogate has the duty to act for you and to make all health care decisions for you during your period of incapacity. He or she may also be provided with access to your medical records, apply for public benefits such as Medicare and Medicaid on your behalf, admit you into a nursing home, and designate your preference for guardian of your person, if that should become necessary.

It is advisable that you choose an alternate surrogate in the event the individual you chose to serve as your health care surrogate is unable to do so. If you fail to choose an alternate and your initial surrogate is unable to serve, it’s possible that the health care facility could seek to have a court appointed proxy to serve in that position, which could result in a stranger making important decisions regarding your health care.

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