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Appendix B: hospital visitation authorization.

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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No portion of this article can be reproduced without the express written permission from the copyright holder.
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Publication:Life Lines: Documents to Protect You and Your Family in Times of Trouble
Geographic Code:1USA
Date:Jan 1, 2003
Words:274
Previous Article:Appendix A: autopsy and disposition of remains.
Next Article:Appendix C: durable power of attorney for finances.
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