ÿWPC, ²-ÞOˆóìè°êÕ8‰jôþ™JÉ  6°ºœ*]HÿBó¬.Dõ~ú‡'Þ¤C2õŽ”_,áSã£8޾]è¹—§©GHB‡ œ0rÍõ$©tu|°‡5‹¥ß§«%ÁÁ´¬b°:Ðt2úÎ4Ã$ZVë¼0ËÛý¼Î%¬!‚& MuDø ±ÀÛ.mæÆBÖ¶¢‘©S`÷ÚyºgãUEˆ¼¬’1À™ ìÇ*aÊødë|©-¾‘ßoŸGƒ’œ8 1‹œ½ú÷;W 9±ÓqèˆûRzyÿWQEP|<ÞÚ[ä8Ñø#+Øïeg˜ÑíËóY·êt¾Å){9¦ó7 `ßaÈ×Àñ•‡r¸ýÜ2Ó…lÇžÕÊ/Z?踣ƒ)'ÊDvð.Áë#‘­$‹£¹&ºZßbµ8ö/U" ©”)/´ÌϬõôŽà©ô%‡³e­º¢"#!ÄUNå %3 0k9UN¤^ òw@þ4>Ra mc+z 0‡¥˜Brother MFC-P2000 series,È,,,,,È0(ÖÃ9 Z‹6Times New Roman RegularX(C$¡¡Ô€XxnXXXÔÔ  ÔÔ  ÔÓ  Ó(ÖÃ9 Z ‹6Times New Roman Regular°­û&¬ P£Q£RRSRTDUDV£W£XUYÒs]ï&ent<Þƒ3|x]ÿU‹ÿÀÀÀ !Ý ƒ ×v*ÝÔ€Xô~XXXÔÔ  ÔÔ  ÔÓ  ÓÝ  ÝÔ_Ôòòò òÔ‡Xô~XÐXô~ÔóóòòDIRECTIVE€TO€PHYSICIANS€AND€FAMILY€OR€SURROGATESà€ö ö ö (#àPAGE€Ú  Ú1Ú  Úóóó óÔ#†Xô~XXXô~t#Ô(_3×v$ªªÝ ƒ!ÝÔ€Xô~XXXÔÔ  ÔÔ  ÔÓ  ÓÝ  ÝÝ ƒ!ÝÔ€Xô~XXXÔÔ  ÔÔ  ÔÓ  ÓÝ  ÝÔ_ÔòòÔ‡Xô~XXXô~ÔÓ  Óòòò òóóñYñÖ€ ÿÿÖñYñDIRECTIVE€TO€PHYSICIANS€AND€FAMILY€OR€SURROGATESó óóóÐ ° ÐÌÓ  ÓInstructions€for€completing€this€document:€ÌÌà  àThis€is€an€important€legal€document€known€as€an€Advance€Directive.€€It€is€designed€to€helpÏyou€communicate€your€wishes€about€medical€treatment€at€some€time€in€the€future€when€you€areÏunable€to€make€your€wishes€known€because€of€illness€or€injury.€€These€wishes€are€usually€based€onÏpersonal€values.€€In€particular,€you€may€want€to€consider€what€burdens€or€hardships€of€treatment€youÏwould€be€willing€to€accept€for€a€particular€amount€of€benefit€obtained€if€you€were€seriously€ill.ÌÌà  àYou€are€encouraged€to€discuss€your€values€and€wishes€with€your€family€or€chosenÏspokesperson,€as€well€as€your€physician.€€Your€physician,€other€health€care€provider,€or€medicalÏinstitution€may€provide€you€with€various€resources€to€assist€you€in€completing€your€advanceÏdirective.€€Brief€definitions€are€listed€below€and€may€aid€you€in€your€discussions€and€advanceÏplanning.€€Initial€the€treatment€choices€that€best€reflect€your€personal€preferences.€€Provide€a€copyÏof€your€directive€to€your€physician,€usual€hospital,€and€family€or€spokesperson.€€Consider€a€periodicÏreview€of€this€document.€€By€periodic€review,€you€can€best€assure€that€the€directive€reflects€yourÏpreferences.ÌÌà  àIn€addition€to€this€advance€directive,€Texas€law€provides€for€two€other€types€of€directives€thatÏcan€be€important€during€a€serious€illness.€€These€are€the€Medical€Power€of€Attorney€and€theÏOut-of-Hospital€Do-Not-Resuscitate€Order.€€You€may€wish€to€discuss€these€with€your€physician,Ïfamily,€hospital€representative,€or€other€advisers.€€You€may€also€wish€to€complete€a€directive€relatedÏto€the€donation€of€organs€and€tissues.ÌÌÓ  ÓDIRECTIVEÌÌÓ  Óà  àI,€______________,€recognize€that€the€best€health€care€is€based€upon€a€partnership€of€trustÏand€communication€with€my€physician.€€My€physician€and€I€will€make€health€care€decisions€togetherÏas€long€as€I€am€of€sound€mind€and€able€to€make€my€wishes€known.€€If€there€comes€a€time€that€I€amÏunable€to€make€medical€decisions€about€myself€because€of€illness€or€injury,€I€direct€that€theÏfollowing€treatment€preferences€be€honored:ÌÌà  àIf,€in€the€judgment€of€my€physician,€I€am€suffering€with€a€terminal€condition€from€which€IÏam€expected€to€die€within€six€months,€even€with€available€life-sustaining€treatment€provided€inÏaccordance€with€prevailing€standards€of€medical€care:ÌÌà8  à____à0` Ð Ð àI€request€that€all€treatments€other€than€those€needed€to€keep€me€comfortable€Ð ø&H"% Ðbe€discontinued€or€withheld€and€my€€physician€allow€me€to€die€as€gently€asÏpossible;€ORÐ ` Ð ` Ð  ÐÌà8  à____à0` Ð Ð àI€€request€€that€I€be€kept€alive€in€this€€terminal€€condition€using€€availableÐ ¨*ø%) Ðlife-sustaining€€treatment.€€(THIS€SELECTION€DOES€NOT€APPLY€TOÐ ”+ä&* ÐHOSPICE€CARE.)Ð ` Ð ` Ð  ÐÌà  àIf,€in€the€judgment€of€my€physician,€I€am€suffering€with€an€irreversible€condition€so€that€IÏcannot€care€for€myself€or€make€decisions€for€myself€and€am€expected€to€die€without€life-sustainingÏtreatment€provided€in€accordance€with€prevailing€standards€of€care:ÌÌà8  à____à0` Ð Ð àI€request€that€all€treatments€other€than€those€needed€to€keep€me€comfortable€Ð 8 ˆ Ðbe€discontinued€or€withheld€and€my€€physician€allow€me€to€die€as€gently€asÏpossible;€ORÐ ` Ð ` Ð  ÐÌà8  à____à0` Ð Ð àI€request€that€I€be€kept€alive€in€this€irreversible€condition€using€€available€Ð è 8  Ðlife-sustaining€treatment.€€(THIS€SELECTION€DOES€NOT€APPLY€TOÏHOSPICE€CARE.)Ð ` Ð ` Ð  ÐÌà  àAdditional€requests:€€(After€discussion€with€your€physician,€you€may€wish€to€consider€listingÏparticular€treatments€in€this€space€that€you€do€or€do€not€want€in€specific€circumstances,€such€asÏartificial€nutrition€and€fluids,€intravenous€antibiotics,€etc.€€Be€sure€to€state€whether€you€do€or€do€notÏwant€the€particular€treatment.)ÌÌñPñÓ  ÓñPñ___________________________________________________________________Ì___________________________________________________________________Ì___________________________________________________________________ÌñQñÓ  ÓñQñà  àAfter€signing€this€directive,€if€my€representative€or€I€elect€hospice€care,€I€understand€andÏagree€that€only€those€treatments€needed€to€keep€me€comfortable€would€be€provided€and€I€would€notÏbe€given€available€life-sustaining€treatments.ÌÌà  àIf€I€do€not€have€a€Medical€Power€of€Attorney,€and€I€am€unable€to€make€my€wishes€known,ÏI€designate€the€following€person(s)€to€make€treatment€decisions€with€my€physician€compatible€withÏmy€personal€values:ÌÌñTññRñà8  àñRññTññVñÓ  ÓñVñ1._____________________ÌñUññSñà8  àñSññUñ2._____________________ÌÌñWñÓ  ÓñWñ(If€a€Medical€Power€of€Attorney€has€been€executed,€then€an€agent€already€has€been€named€and€youÏshould€not€list€additional€names€in€this€document.)ÌÌà  àIf€the€above€persons€are€not€available,€or€if€I€have€not€designated€a€spokesperson,€IÏunderstand€that€a€spokesperson€will€be€chosen€for€me€following€standards€specified€in€the€laws€ofÏTexas.€€If,€in€the€judgment€of€my€physician,€my€death€is€imminent€within€minutes€to€hours,€even€withÏthe€use€of€all€available€medical€treatment€provided€within€the€prevailing€standard€of€care,€IÏacknowledge€that€all€treatments€may€be€withheld€or€removed€except€those€needed€to€maintain€myÏcomfort.€€I€understand€that€under€Texas€law€this€directive€has€no€effect€if€I€have€been€diagnosed€asÏpregnant.€€This€directive€will€remain€in€effect€until€I€revoke€it.€€No€other€person€may€do€so.ÌÐ T,¤'+ ÐSigned__________________________________Date______________________ÌÌCity,€County,€State€of€Residence€__________________________________ÌÌà  àTwo€competent€adult€witnesses€must€sign€below,€acknowledging€the€signature€of€theÏdeclarant.€€The€witness€designated€as€Witness€1€may€not€be€a€person€designated€to€make€a€treatmentÏdecision€for€the€patient€and€may€not€be€related€to€the€patient€by€blood€or€marriage.€€This€witness€mayÏnot€be€entitled€to€any€part€of€the€estate€and€may€not€have€a€claim€against€the€estate€of€the€patient.€ÏThis€witness€may€not€be€the€attending€physician€or€an€employee€of€the€attending€physician.€€If€thisÏwitness€is€an€employee€of€a€health€care€facility€in€which€the€patient€is€being€cared€for,€this€witnessÏmay€not€be€involved€in€providing€direct€patient€care€to€the€patient.€€This€witness€may€not€be€anÏofficer,€director,€partner,€or€business€office€employee€of€a€health€care€facility€in€which€the€patientÏis€being€cared€for€or€of€any€parent€organization€of€the€health€care€facility.ñXñÌñXñÌWitness1________________________Witness2_________________________ÌÌDefinitions:ÌÌà  à"Artificial€nutrition€and€hydration"€means€the€provision€of€nutrients€or€fluids€by€a€tubeÏinserted€in€a€vein,€under€the€skin€in€the€subcutaneous€tissues,€or€in€the€stomach€(gastrointestinalÏtract).ÌÌà  à"Irreversible€condition"€means€a€condition,€injury,€or€illness:ÌÌà  àà ` à(1)that€may€be€treated,€but€is€never€cured€or€eliminated;ÌÌà  àà ` à(2)that€leaves€a€person€unable€to€care€for€or€make€decisions€for€the€person's€own€self;ÏandÌÌà  àà ` à(3)that,€without€life-sustaining€treatment€provided€in€accordance€with€the€prevailingÏstandard€of€medical€care,€is€fatal.ÌÌà  àExplanation:Many€serious€illnesses€such€as€cancer,€failure€of€major€organs€(kidney,€heart,Ïliver,€or€lung),€and€serious€brain€disease€such€as€Alzheimer's€dementia€may€be€consideredÏirreversible€early€on.€€There€is€no€cure,€but€the€patient€may€be€kept€alive€for€prolonged€periods€ofÏtime€if€the€patient€receives€life-sustaining€treatments.€€Late€in€the€course€of€the€same€illness,€theÏdisease€may€be€considered€terminal€when,€even€with€treatment,€the€patient€is€expected€to€die.€€YouÏmay€wish€to€consider€which€burdens€of€treatment€you€would€be€willing€to€accept€in€an€effort€toÏachieve€a€particular€outcome.€€This€is€a€very€personal€decision€that€you€may€wish€to€discuss€withÏyour€physician,€family,€or€other€important€persons€in€your€life.ÌÌà  à"Life-sustaining€treatment"€means€treatment€that,€based€on€reasonable€medical€judgment,Ïsustains€the€life€of€a€patient€and€without€which€the€patient€will€die.€€The€term€includes€bothÏlife-sustaining€medications€and€artificial€life€support€such€as€mechanical€breathing€machines,€kidneyÐ T,¤'+ Ðdialysis€treatment,€and€artificial€hydration€and€nutrition.€€The€term€does€not€include€theÏadministration€of€pain€management€medication,€the€performance€of€a€medical€procedure€necessaryÏto€provide€comfort€care,€or€any€other€medical€care€provided€to€alleviate€a€patient's€pain.ÌÌà  à"Terminal€condition"€means€an€incurable€condition€caused€by€injury,€disease,€or€illness€thatÏaccording€to€reasonable€medical€judgment€will€produce€death€within€six€months,€even€with€availableÏlife-sustaining€treatment€provided€in€accordance€with€the€prevailing€standard€of€medical€care.ÌÌà  àExplanation:€€Many€serious€illnesses€may€be€considered€irreversible€early€in€the€course€ofÏthe€illness,€but€they€may€not€be€considered€terminal€until€the€disease€is€fairly€advanced.€€In€thinkingÏabout€terminal€illness€and€its€treatment,€you€again€may€wish€to€consider€the€relative€benefits€andÏburdens€of€treatment€and€discuss€your€wishes€with€your€physician,€family,€or€other€important€personsÏin€your€life.Ô#†Xô~XXXô~q#Ô