Forms

Advance directive:
Loganville family medicine will provide you with copies of this document and assistance in completing the forms, if you wish.
N THE STATE OF GEORGIA, all competent adults have the right to be informed about their medical treatment and to refuse that treatment for any reason. Sometimes this can be confusing, especially while you are a hospital patient or are in need of medical care. The best way to be sure your voice is heard in a medical setting is to write down your wishes in advance.
The new GEORGIA ADVANCE DIRECTIVE FOR HEALTHCARE has four parts:
PART ONE—Health Care Agent. This part allows you to choose someone to make health care decisions for you when you cannot (or do not want to) make health care decisions for yourself. The person you choose is called a health care agent. You may also have your health care agent make decisions for you after your death with respect to an autopsy, organ donation, body donation, and final disposition of your body. You should talk to your health care agent about this important role.
PART TWO—Treatment Preferences. This part allows you to state your treatment preferences if you have a terminal condition or if you are in a state of permanent unconsciousness.
PART TWO will become effective only if you are unable to communicate your treatment preferences. Reasonable and appropriate efforts will be made to communicate with you about your treatment preferences before PART TWO becomes effective. You should talk to your family and others close to you about your treatment preferences.
PART THREE—Guardianship. This part allows you to nominate a person to be your guardian should one ever be needed.
PART FOUR—Effectiveness and Signatures. This part requires your signature and the signatures of two witnesses. You must complete PART FOUR if you have filled out any other part of this form.

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HIPPA forms

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All patients are required to complete the HIPPA Privacy form in the office.