The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. The declaration may be substantially in the following form, but not to the exclusion of other written and clear expressions of intent to accept, refuse, or withdraw medical care: Click here to view form. Acts 1985, ch. 355, § 5; 1991, ch. 344, § 6. 11_105_1 - Attachment
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