North Carolina General Statutes
Article 3 - Clients' Rights and Advance Instruction.
§ 122C-77 - Statutory form for advance instruction for mental health treatment.

122C-77. Statutory form for advance instruction for mental health treatment.
(a) This Part shall not be construed to invalidate an advance instruction for mental health treatment that was executed and was otherwise valid.
(b) The use of the following or similar form after the effective date of this Part in the creation of an advance instruction for mental health treatment is lawful, and, when used, it shall specifically meet the requirements and be construed in accordance with the provisions of this Part.
1. Name:_______________________________________________________________
2. Name:_______________________________________________________________
3. My Physician:
4. My Therapist:
a. The attending physician or mental health service provider or an employee of the physician or mental health treatment provider;
b. An owner, operator, or employee of an owner or operator of a health care facility in which the principal is a patient or resident; or
c. Related within the third degree to the principal or to the principal's spouse.
(1997-442, s. 2; 1998-198, s. 2; 1998-217, s. 53(a)(5); 2019-240, s. 26(d).)

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