Michigan Advance Directive

Information you will need

• Successor Advocate Name
• Advocate Relation
• Successor Advocate Relation
• Advocate Address
• Successor Advocate Address
• Outpatient Therapy
• Voluntary Mental Health Services
• Involuntary Mental Health Services
• Psychotropic Medication
• Electroconvulsive Therapy
• Right to Revoke
• LIst of Organs or Parts
• Specific Wishes
• Recipient of Donation
• Principal Address and Phone
• Principal Name
• Medical Treatment Preferences
• Advocate: Principal Name
• Execution Date
• Second Witness Name
• First Witness Name
• First Witness Address
• Second Witness Address
• Principal Signing Date

…and 17 more fields in the PDF.

Completed by the declarant and the employee.

The form includes 5 signature lines, a witness section.