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Form - 20 Pa. Cons. Stat. § 5465

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     § 5465.  Form.
        A health care power of attorney may be in any written form
     identifying the principal, appointing a health care agent and
     declaring that the principal authorizes the health care agent to
     make health care decisions on behalf of the principal. An
     example of a health care power of attorney appears in the
     combined form set forth in Subchapter D (relating to combined
     form).

Last modified: November 27, 2007