Appendix B: hospital visitation authorization.
I, --, a resident of -- County, State of --, do hereby give notice and authorize that, if any injury or illness, or any incapacity through any other cause necessitates my hospitalization or treatment in a medical facility, it is my wish that -- be given first preference in being admitted to visit me in such facility, whether or not there are parties related to me by blood or by law or other parties desiring to visit me, unless and until I freely give contrary instructions to competent medical personnel on the premises involved.
Executed this -- day of --, 20 --, at
Signature of Principal
CERTIFICATE OF ACKNOWLEDGMENT OF NOTARY PUBLIC
State of --) ) SS. County of --) On -- before me, --, personally (Date) (Notary) appeared -- Signer(s) Personally known to me - OR - proved to me on the basis of satisfactory evidence to be the person(s) whose name(s) is/are subscribed to the within instrument and acknowledged to me that he/she/they executed the same in his/her/their authorized capacity(ies), and that by his/her/their signature(s) on the instrument the person(s), or the entity upon behalf of which the person(s) acted, executed the instrument. WITNESS my hand and official seal. -- Notary's Signature
IMPORTANT NOTE: This sample legal document is provided for informational purposes only and may or may not be valid in your state. This sample legal document also may not include the particular provisions you need. We strongly recommend you consult a competent family or estate planning attorney who is familiar with these issues. This sample document in no way constitutes, and should not be relied upon, as legal advice.
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|Publication:||Life Lines: Documents to Protect You and Your Family in Times of Trouble|
|Date:||Jan 1, 2003|
|Previous Article:||Appendix A: autopsy and disposition of remains.|
|Next Article:||Appendix C: durable power of attorney for finances.|