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New Mexico Living Will AND/OR New Mexico Durable Power of Attorney
(In compliance with the Patient Self-determination Act 1990)
Patient Self-determination Information Verification
If yes, complete the following information:
Information on Individual with Durable Power of Attorney and/or Living Will for Health Care Decisions:
If yes, place a copy of LIVING WILL (Right to Die) and/or DURABLE POWER of ATTORNEY for healthcare decisions in medical record.
If no, information concerning advance medical directives, including information describing the DURABLE POWER of ATTORNEY and LIVING WILLS has been given to this patient.
This health center receives HHS funding and has Federal Public Health (PHS) deemed status with respect to certain health or health-related claims, including medical malpractice claims, for itself and its covered individuals.
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To make an appointment, please contact one of our convenient locations...
Portales: (575) 356-6695ENMU: (575) 562-2321Clovis: (575) 769-0888Roswell: (575) 623-3255Roswell Pediatrics: (575) 622-5956ENMU Roswell: (575) 624-7106Roswell Behavioral: (575) 755-2272