Sec. 02.06.03.06. Preparation of the Form

A. A patient or proxy who is considering use of the Form shall be offered assistance by:

(1) The patient's attending physician; or

(2) Another health care provider who:

(a) Has been determined by the attending physician to have the knowledge and skills to properly conduct a discussion about the form; and

(b) Acts under the general direction of the attending physician.

B. If the form is used by a proxy on behalf of a patient who has an advance directive in the patient's medical records, the health care provider preparing the form shall take reasonable steps to ensure that entries made by the proxy are consistent with the advance directive.

C. A patient or proxy that completes any part of the form shall initial that part.

D. The form shall be signed by:

(1) The patient or proxy;

(2) The patient's attending physician; and

(3) If another health care provider prepared the form, that health care provider.

E. A health care provider may initial a part of a form or sign a form on behalf of a patient or proxy if:

(1) The patient or proxy is unable to initial or sign personally;

(2) The patient or proxy expressly directs the health care provider to initial or sign on behalf of the patient or proxy; and

(3) The health care provider documents the circumstances in the patient's medical record.