Advance directive · New York · standing instrument
Confirm this is your patient
Margaret Ellison Hale
Full date of birth appears on the signed PDF below.
Clause 1 of 2
Executed refusal under New York’s anatomical gift act (N.Y. Pub. Health Law §§ 4301, 4305). I, Margaret Ellison Hale, expressly refuse to make an anatomical gift of my body or any part of it, and I revoke any prior registry entry or document of gift. No family member, surrogate, agent, hospital administrator, or other person may authorize an anatomical gift on my behalf.
Clause 2 of 2
Prophylaxis after a suspected exposure is accepted. Tetanus, rabies and hepatitis B prophylaxis may be given.
This is not a DNR.
Margaret Ellison Hale accepts full treatment and resuscitation. This instrument refuses only the interventions above — nothing else here limits care.
It contains no DNR, POLST or code-status instruction. If one exists, it is a separate document.
Signed instrument
Healthcare agent
Daniel Hale — son
Call (212) 555-0142Entered by the holder · not reviewed by WearableDocs
Severe penicillin allergy. On anticoagulants.
Rescue inhaler in handbag. Difficult intubation noted 2019.
Updated 19 JUL 2026
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