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Signature of Patient or Health Care Proxy or Legal Guardian Date ATTENDING PHYSICIAN'S ORDER I, the undersigned, state that I am the physician for the patient named above. I hereby direct any and all qualified Emergency Medical Services personnel, commencing on the effective date noted below, to withhold cardiopulmonary resuscitation (cardiac compression, endotracheal intubation and other advanced airway management, artificial ventilation, defibrillation, administration of.

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