Policy Manual sample

MDT Home Health Care Agency, Inc. If there is anything in this document that you do not understand, you should ask a lawyer to explain it to you. Your agent may need this document immediately, in case of an emergency that requires a decision concerning your healthcare. Either keep this document where it is immediately available to your agent and alternate agents, or give each of them an executed copy of this document. You may also want to give your physician an executed copy of this document. Do not use this form if you are a conservatee under the Lanterman-Petris-Short Act and you want to appoint your conservator as your agent. You can do that only if the appointment document includes a certificate of your attorney. Home Health Agency Miscellaneous M-5