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Parsons Technology resource data  |  1995-05-23  |  2.1 KB  |  59 lines
  1. PARSONS TECHNOLOGY RESOURCE FILE
  2. RAD01001
  3. RAD01002o
  4. RAD01003
  5. RAD01032u
  6. RAD02002
  7. RAD03002
  8. RAD03255m
  9. RAD04002V
  10. RAD04010
  11. State: |
  12. REVADD01
  13. 2In what state does the Declarant currently reside?
  14. RAD01003
  15. Name: |Address 1: |Address 2: |City: |State: |Zip: |[Include country]Country: |[Include SSN]SSN: |
  16. REVADD01
  17. VWhat is the name and address of the person who made the Advance Health Care Directive?
  18. RAD01032
  19. Title: |Date: |
  20. REVADD01
  21. AWhat is the title and date of the document that is being revoked?
  22. Enter the title of the Advance Health Care Directive as it appears in the document that will be revoked.  For example, "Medical Directive" or "Advance Health Care Directive".  Press [Ctrl+F1] for more information.
  23. RAD01002
  24. Yes, an agent was designated.
  25. REVADD01
  26. xIn the Advance Directive that is being revoked, was an agent designated to make health care decisions for the Declarant?
  27. {NEXT_?}
  28. City: |State: |
  29. REVADD02
  30. %Where will this revocation be signed?
  31. {NEXT_?}
  32. Name: |
  33. Address 1: |
  34. Address 2: |
  35. City: |
  36. State: |
  37. Zip: |
  38. [Include country]
  39. Country: |
  40. REVADD03
  41. 2What are the names and addresses of the witnesses?
  42. {NEXT_?}
  43. RAD03002
  44. Yes, include witness name and address.
  45. REVADD03
  46. +Do you wish to include witness information?
  47. RAD03002
  48. {NEXT_?}
  49. Name: |
  50. REVADD04
  51. +Who has received a copy of this revocation?
  52. RAD04010
  53. Name: |
  54. REVADD04
  55. 0Who else has received a copy of this revocation?
  56. Enter the name of a person or institution who has been given a copy of the revocation or use the P.I. Manager to select and paste a record.  Press "Next" when there are no more names to enter.
  57. {NEXT_?}
  58. RAD04010
  59.