Loading
Form preview picture

Get 2015 Veterans Directive 2020-2024

The OMB Control No. for this information collection is 2900-0556. VA FORM JUL 2015 10-0137 Page 1 of 7 PART II DURABLE POWER OF ATTORNEY FOR HEALTH CARE This section of the advance directive form is called a Durable Power of Attorney for Health Care. OMB Approval Number 2900-0556 Estimated Burden Avg 30 minutes Expiration Date 10/31/2017 VA ADVANCE DIRECTIVE DURABLE POWER OF ATTORNEY FOR HEALTH CARE AND LIVING WILL This advance directive form is an official document where you can write down your preferences for your health care. I am not financially responsible for the care of the person making this advance directive. To the best of my knowledge I am not named in the person s will. Name Printed or Typed This VA Advance Directive form is valid in VA facilities without being notarized. However you may need to have it notarized to be legally binding outside the VA health care setting. DATE SIGNATURE B - WITNESSES SIGNATURES Two people must witness your signature. VA employees may be witnesses if they are members of l The Chaplain Service l The Social Work Service l Nonclinical employees e.g. Medical Administration Service Voluntary Service or Environmental Management Service Other employees of your VA facility may not sign as witnesses to your advance directive unless they re in your family. If someday you can t make health care decisions for yourself anymore this advance directive can help guide the people who will make decisions for you. You can use this form to l Name specific people to make health care decisions for you l Describe your preferences for how you want to be treated care When you complete this form it s important that you also talk to your doctor family and other loved ones who may help to decide about your care. You should explain what you meant when you filled out the form* A health care professional can help you with this form and can answer any questions that you have. If you need more space for any part of the form you may attach extra pages. Be sure to initial and date every page that you attach. PART I PERSONAL INFORMATION NAME Last First Middle LAST FOUR DIGITS OF SSN STREET ADDRESS CITY STATE ZIP HOME PHONE WITH AREA CODE WORK PHONE WITH AREA CODE MOBILE PHONE WITH AREA CODE Privacy Act Information and Paperwork Reduction Act Notice The information requested on this form is solicited under the authority of 38 C. F*R* 17. 32. It is being collected to document your preferences for your health care in the event that you can t speak for yourself anymore. The information you provide may be disclosed outside the VA as permitted by law. Possible disclosures include those that are described in the routine uses identified in the VA system of records 24VA19 Patient Medical Record-VA published in the Federal Register in accordance with the Privacy Act of 1974. This is also available in the Compilation of Privacy Act Issuances at http //www. gpoaccess. gov/privacyact/index. html* You may choose to fill out this form or not. But without this information VA the benefits you are entitled to receive.

How It Works

va form 10 0137 fillable rating
4.8Satisfied
26 votes

Tips on how to fill out, edit and sign 2015 va durable online

How to fill out and sign Printable va form 10 0137 online?

Get your online template and fill it in using progressive features. Enjoy smart fillable fields and interactivity. Follow the simple instructions below:

The days of distressing complicated legal and tax documents have ended. With US Legal Forms the process of filling out legal documents is anxiety-free. The leading editor is right close at hand providing you with an array of beneficial tools for completing a VA 10-0137. These tips, along with the editor will guide you through the complete procedure.

  1. Click the Get Form option to begin editing and enhancing.
  2. Activate the Wizard mode on the top toolbar to acquire extra recommendations.
  3. Fill every fillable area.
  4. Be sure the details you add to the VA 10-0137 is up-to-date and accurate.
  5. Include the date to the record using the Date tool.
  6. Click on the Sign button and create a signature. You can use 3 available choices; typing, drawing, or uploading one.
  7. Re-check every field has been filled in properly.
  8. Click Done in the top right corne to save or send the form. There are many choices for receiving the doc. As an instant download, an attachment in an email or through the mail as a hard copy.

We make completing any VA 10-0137 easier. Use it now!

Get form

Experience a faster way to fill out and sign forms on the web. Access the most extensive library of templates available.

Video instructions and help with filling out and completing va form 10 0137 printable

Take advantage of our instructional video guide for filling in and delivering Form with our online editor. Start now so you can enjoy relaxing later on.

2006 advance FAQ

Get This Form Now!

Use professional pre-built templates to fill in and sign documents online faster. Get access to thousands of forms.

Keywords relevant to va form 100137

  • va advance
  • va advance directive
  • va advance directive durable power of attorney
  • va advance directive for health care
  • va advance directive for healthcare
  • va advance directive form
  • va advance directive form 10 0137
  • va advance directive form 2020
  • va advance directive handbook
  • va advance directive pdf
  • va advance directives
  • va advance directives form
  • va advance health care directive
  • va advance information
  • va advance medical directive form
If you believe that this page should be taken down, please follow our DMCA take down processhere.
Ensure the security of your data and transactions

USLegal fulfills industry-leading security and compliance standards.

  • 
                            VeriSign logo picture

    VeriSign secured

    #1 Internet-trusted security seal. Ensures that a website is free of malware attacks.

  • Accredited Business

    Guarantees that a business meets BBB accreditation standards in the US and Canada.

  • 
                            TopTenReviews logo picture

    TopTen Reviews

    Highest customer reviews on one of the most highly-trusted product review platforms.