Page 281 - Demo

BOX SIX – ORGAN AND TISSUE DONATION
I DO (delete if inapplicable)
I DO NOT (delete if inapplicable)
give consent for [any part of my body]
[the following parts of my body ... ] to be removed after my death and used for therapeutic purposes
BOX SEVEN – PEOPLE TO BE WITH ME AND TO BE CONSULTED
I would like the following person(s) to be contacted to invite them to come and be by my side if I am likely to die within a relatively short time.
Person 1 - Full name
Address
Home telephone
Mobile telephone
Person 2 - Full name
Address
Home telephone
Mobile telephone
I would like the following person(s) to be informed of my medical condition, to be consulted and for their views taken into account in respect of any decisions relating to my healthcare if I am not able to make decisions for myself.
Person 1 - Full name
Address
Home telephone
Mobile telephone
Appendix E 277