§ 11-106. Form of advance directive--Designation and authority of attorney-in-fact
Oklahoma Statutes AnnotatedTitle 43A. Mental Health
43A Okl.St.Ann. § 11-106
§ 11-106. Form of advance directive--Designation and authority of attorney-in-fact
A. A declaration stating the mental health treatment wishes of the declarant executed in accordance with the provisions of this act1 shall be substantially in the form provided by subsection E of this section.
B. A declarant may designate a capable person eighteen (18) years of age or older to act as attorney-in-fact to make mental health treatment decisions. An alternative attorney-in-fact may also be designated to act as attorney-in-fact if the original attorney-in-fact is unable or unwilling to act at any time. An appointment of an attorney-in-fact shall be substantially in the form provided by subsection E of this section.
C. An attorney-in-fact who has accepted the appointment in writing shall have authority to make decisions, in consultation with the attending physician or psychologist, about mental health treatment on behalf of the declarant only when the declarant is certified as incapable and to require mental health treatment as provided by Section 10 of this act.2
D. An attorney-in-fact may withdraw by giving notice to the declarant. If a declarant is incapable, the attorney-in-fact may withdraw by giving notice to the named alternative attorney-in-fact if any, and if none then to the attending physician or provider. The attending physician or provider shall note the withdrawal of the last named attorney-in-fact as part of the declarant's medical record.
ADVANCE DIRECTIVE FOR MENTAL HEALTH TREATMENT
I, _____________________, being of sound mind and eighteen (18) years of age or older, willfully and voluntarily make known my wishes about mental health treatment, by my instructions to others through my advance directive for mental health treatment, or by my appointment of an attorney-in-fact, or both. I thus do hereby declare:
If my attending physician or psychologist and another physician or psychologist determine that my ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that I lack the capacity to refuse or consent to mental health treatment and that mental health treatment is necessary, I direct my attending physician or psychologist and other health care providers, pursuant to the Advance Directives for Mental Health Treatment Act,1 to provide the mental health treatment I have indicated below by my signature.
I understand that “mental health treatment” means convulsive treatment, treatment with psychoactive medication, and admission to and retention in a health care facility for a period up to twenty-eight (28) days.
I direct the following concerning my mental health care:
I further state that this document and the information contained in it may be released to any requesting licensed mental health professional.
____________________ | ||
Declarant's Signature | Date | |
____________________ | ||
Witness 1 | Date | |
____________________ | ||
Witness 2 | Date |
If my attending physician or psychologist and another physician or psychologist determine that my ability to receive and evaluate information effectively or communicate decisions is impaired to such an extent that I lack the capacity to refuse or consent to mental health treatment and that mental health treatment is necessary, I direct my attending physician or psychologist and other health care providers, pursuant to the Advance Directives for Mental Health Treatment Act, to follow the instructions of my attorney-in-fact.
I hereby appoint:
NAME _________________
ADDRESS _______________
TELEPHONE #____________
to act as my attorney-in-fact to make decisions regarding my mental health treatment if I become incapable of giving or withholding informed consent for that treatment.
If the person named above refuses or is unable to act on my behalf, or if I revoke that person's authority to act as my attorney-in-fact, I authorize the following person to act as my attorney-in-fact:
NAME _________________
ADDRESS _______________
TELEPHONE #____________
My attorney-in-fact is authorized to make decisions which are consistent with the wishes I have expressed in my declaration. If my wishes are not expressed, my attorney-in-fact is to act in what he or she believes to be my best interest.
___________________________________ | ||
(Signature of Declarant/Date) |
I understand that if I have completed both a declaration and have appointed an attorney-in-fact and if there is a conflict between my attorney-in-fact's decision and my declaration, my declaration shall take precedence unless I indicate otherwise.
____________________ ___________ (signature)
a. In the absence of my ability to give directions regarding my mental health treatment, it is my intention that this advance directive for mental health treatment shall be honored by my family and physicians or psychologists as the expression of my legal right to consent or to refuse to consent to mental health treatment.
Signed this ____________ day of____________, 19 ___ |
___________________________________ | ||
(Signature) | ||
___________________________________ | ||
City, County and State of Residence |
This advance directive was signed in my presence. |
___________________________________ | ||
(Signature of Witness) | ||
___________________________________ | ||
(Address) | ||
___________________________________ | ||
(Signature of Witness) | ||
___________________________________ | ||
(Address) |
Credits
Laws 1995, c. 251, § 6, eff. Nov. 1, 1995.
43A Okl. St. Ann. § 11-106, OK ST T. 43A § 11-106
Current with emergency effective legislation through Chapter 106 of the Second Regular Session of the 59th Legislature (2024). Some sections may be more current, see credits for details.
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