Enrollment Procedures. The decision to donate your body to the Program is a serious decision, and we strongly encourage you to discuss your decision with your family. The procedure for enrolling in the Program involves completing this Agreement, which includes the Authorization For Donation, Personal Information, Brief Medical History, and Authorization For Disclosure of Health Information, and sending one original, signed copy to the Program Coordinator at the above address. It is recommended that a second copy be made for your records, and copies provided to appropriate family members. Wallet cards will then be issued to facilitate communication with Program representatives upon your death, and to communicate this information to family and caretakers. Once you enroll in the Program, the Agreement remains on file in the office of the Department of Pathology and Anatomical Sciences permanently. If you decide to revoke the Agreement, the “Notice of Revocation of Authorization for Donation of Body” must be sent to the Program Coordinator at the above address. Your donation cannot be revoked or overridden by any other person at any time, even after your death.
Appears in 3 contracts
Samples: Gift of Body Program Agreement, Gift of Body Program Agreement, Gift of Body Program Agreement
Enrollment Procedures. The decision to donate your body to the Program is a serious decision, and we strongly encourage you to discuss your decision with your family. The procedure for enrolling in the Program involves completing this Agreement, which includes the Authorization For Donation, Personal Information, Brief Medical History, and Authorization For Disclosure of Health Information, and sending one original, signed copy to the Program Coordinator at the above address. It is recommended that a second copy be made for your records, and copies provided to appropriate family members. Wallet cards will then be issued to facilitate communication with Program representatives upon your death, and to communicate this information to family and caretakers. Once you enroll in the Program, the Agreement remains on file in the office of the Department of Pathology and Anatomical Sciences permanently. If you decide to revoke the Agreement, the “Notice of Revocation of Authorization for Donation of Body” must be sent to the Program Coordinator at the above address. Your donation cannot be revoked or overridden by any other person at any time, even after your death.
Appears in 1 contract
Samples: Gift of Body Program Agreement