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Justice Center for the Protection of People with Special Needs

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  2. » Surrogate Decision-Making Committee (SDMC)
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  4. » Forms Needed for Major Medical Treatment

(200) Declaration for Major Medical Treatment

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(200) Declaration for Major Medical Treatment.pdf

PDF icon (200) Declaration for Major Medical Treatment

Agency Directory

  • Surrogate Decision-Making Committee (SDMC)
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      • Forms Needed for Major Medical Treatment
        • (200) Declaration for Major Medical Treatment
        • (210) Certification on Capacity for Major Medical Treatment
        • (220-A) Certification on Need for Major Medical Treatment
        • (220-B) Related Medical Information
      • Sample Forms Needed for Major Medical Treatment
        • Sample - (200) Declaration for Major Medical Treatment
        • Sample - (210) Certification on Capacity for Major Medical Treatment
        • Sample - (220-A) Certification on Need for Major Medical Treatment
        • Sample - (220-B) Related Medical Information
      • Forms Needed for End of Life Care
        • (300) Declaration for End of Life Care
        • (310) Certification on Capacity for End of Life Care
        • (320-AB) Attending Physician and Concurring Physician Certification for End of Life Care
        • (330) Related Medical Information for End of Life Care
      • Sample Forms Needed for End of Life Care
        • Sample - (300) Declaration for End of Life Care
        • Sample - (310) Certification on Capacity for End of Life Care
        • Sample - (320-AB) Attending and Concurring Physician Certification for End of Life Care
        • Sample - (330) Related Medical Information for End of Life Care
      • Sample - (380-A) MOLST Checklist
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