DOCTORS CERTIFICATE
By Signing below, I certify that:
- I have discussed the contents of this advance care directive with the principal.
- I have no reason to doubt the capacity of the principal to make this advanced care directive; and
- The principal understood the implications of this advance care directive.
Name ____________________________________________
Name of practice or facility __________________________________________________
Address of facility or practice __________________________________________________
Phone_____________________________________________
Signature_______________________________
Date __________
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