As the health care industry’s most comprehensive library of customizable policy and procedure templates, MCN Healthcare’s Medical Office Policy and Procedure Manual includes this customizable template, Advance Directive Signed Form - Exhibit M. MCN’s policy library helps you meet compliance with Joint Commission and federal regulations including CMS, CDC, OSHA, OIG, HIPAA and more.

Health care organizations around the world utilize MCN’s compliant ready templates and workflow process tools to help them meet the latest changes in regulations and standards.

Here is some sample content from Advance Directive Signed Form - Exhibit M:

	EXHIBIT M I have filled out a Durable Power of Attorney. My agent is I have not filled out a Durable Power of Attorney, however, I will review the example given to me and may do so at a later time. I have not filled out a Durable Power of Attorney and do not wish to do so. I have filled out a Declaration. I have not filled out a Declaration, however, I will review the example given to me and make a decision at a later time. I have not filled out a Declaration and do not wish to do so. By my signature I acknowledge that I have been given information on my rights to refuse any medical...
Second excerpt:
	...on my rights to refuse any medical or surgical treatment that I may not want. I have also been given information on Patient Directives and I understand that my care will not be compromised by whether or not I sign a Directive. Patient Signature: Witness: Complaints concerning non-compliance with the Advance Directive requirement may be filed with the State Surveyor at . One copy to patient One copy to chart Reference...