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Acknowledgement of Receipt for Advanced Directives 3128/2P

$104.64
In stock
Product Code :
MPSBRG-3128/2P
More Information
MPN 3128/2P
Brand Briggs Health Care
Packaging 100 per pack
Size 8 1/2Inx 11In
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Note : Image shown for reference purposes only. Actual product appearance may vary. Please read product description for full and accurate details.

Document that the resident/legal representative has been informed in writing, in a language understood by the resident/legal representative, of his/her rights, and the rules/regulations regarding Advance Directives and Medical Treatment Decisions.

UPDATED to include:

  • POLST/MOLST or POST/MOST (acronym depends on state designation)
  • Tube/Feeding treatment restrictions
  •  Intubation or ventilator treatment restrictions

  • Size:  8 1/2" x 11" detached
  • 2-part version: White/Canary carbonless stock
  • 3-part version: White/Canary/Pink carbonless stock
  • Punched 5-holes top or side
  • Black ink
  • 100 per pack
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