This Revocation of Anatomical Gift revokes a previously made Organ Donation Agreement. This revocation sets forth the date of the original agreement, the name of the donor and identity of the done. This Revocation of Anatomical Gift must be signed by the original donor.
This Authorization to Disclose Health Information authorizes a health care provider to disclose certain specific health information records to another (such as a prospective employer, insurance company or school). This authorization sets out pertinent patient information, the specific type of information to be disclosed and the name of the individual or organization to receive the information. This authorization includes an expiration date but can be revoked at any time.
This Health Care Power of Attorney form allows an individual to grant someone they trust the authority to make health care decisions on their behalf in the event that they become incapacitated in some way so that they are unable to make those decisions themselves.
This Anatomical Gift by Living Donor is written notification that an individual wants to donate his or her organs upon death. This gift sets out the name of the donor, the specific organs to be donated and the donee. This Anatomical Gift by Living Donor must be signed and dated by the donor in the presence of two witnesses.
Authorizations to Disclose Health Information are used when you desire to allow others to disclose information regarding your health. This authorization spells out the specific information to be disclosed, who is authorized to do so and the purposes for disclosure. You may revoke the authorization at any time.