[§327F-8] Written certification. (a) An attending physician who has been notified of the existence of a declaration executed under this chapter shall make all reasonable efforts to obtain the notarized declaration and shall ascertain without delay whether the declarant's current condition corresponds to the condition described in the declaration under which the declaration would take effect.

(b) In the event that a patient's condition corresponds to the condition described in the patient's declaration, a written certification of the declarant's condition shall be made a part of the declarant's medical record and shall be substantially in the following form:

CERTIFICATION OF CONDITION SPECIFIED

IN PATIENT'S DECLARATION

In my professional opinion, I certify that

______________________________ is not able to participate in

(name of patient)

decisions concerning medical treatment to be administered and has the following condition: ______________________. According to

(diagnosis)

the declaration, ______________________________ wishes to receive

(name of patient)

medical treatment according to a personal medical treatment plan as specified in the patient's declaration, under these circumstances.

Signed

Attending Physician

Signed

Second Attending Physician

[L 1992, c 84, pt of §1]