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Revocation Of Advance Health Care Directive (California) POA-CA 201 - Legal Forms
| Revocation Of Advance Health Care Directive (California) Form. This is a Legal Forms form and can be used in Health Care-Living Wills Power Of Attorney . |
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REVOCATION OF ADVANCE HEALTH CARE DIRECTIVE (California Probate Code Section 4695) Pursuant to California Probate Code Section 4695: (a) A patient having capacity may revoke the designation of an agent only by a signed writing or by personally informing the supervising health care provider. (b) A patient having capacity may revoke all or part of an advance health care directive, other than the designation of an agent, at any time and in any manner that communicates an intent to revoke. I, , Declarant, having executed a Advance Health Care Directive on the day of 20 regarding certain choices and decisions relating to my healthcare in order to make health care decisions on behalf of me. Explanation: California Probate Code Section 4695 provides that I may revoke this Directive regarding the appointment of an agent only in writing or by informing my supervising health care provider and that I may revoke all or part of the other provisions of that Directive at any time and in any manner that communicates an intent to revoke. Revocation: I hereby revoke my healthcare directive dated of 20 .This is my written revocation of the above referenced Directive and I am providing a copy of this revocation to all parties to whom I provided a copy of the original directive. DATED this the day of , 20 . Signature of Declarant: Printed Name of Declarant: Address of Declarant: American LegalNet, Inc. © www.FormsWorkFlow.com
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