Section 4. The health care proxy shall: (i) identify the principal and the health care agent; (ii) indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf; (iii) describe the limitation, if any, that the principal intends to impose upon the agent's authority; and (iv) indicate that the agent's authority shall become effective if it is determined pursuant to section six that the principal lacks capacity to make health care decisions.
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