1. Revocation of My Psychiatric Advance Directive

___________My wish is that this mental health directive may be revoked, suspended or terminated by me at any time, if state law so permits.

2. Revocation of My Psychiatric Advance Directive During a Period of Incapacity

__________ My wish is that this mental health care directive may be revoked, suspended or terminated by me only at times that I have the capacity and competence to do so. I understand that I may be choosing to give up the right to change my mind at any time. I expressly give up this right to ensure compliance with my advance directive. My decision not to be able to change this advance directive while I am incompetent or incapacitated is made to ensure that my previous, carefully considered thoughts about how I want to be treated will remain in effect during the time I am incompetent or incapacitated.

2A. __________ Notwithstanding the above, it is my wish that my agent or other decisionmaker specifically ask me about my preferences before making a decision regarding mental health care, and take the preferences I express here into account when making such a decision, even while I am incompetent or incapacitated,.

3. Other Instructions About Mental Health Care

(Use this space to add any other instructions that you wish to have followed. If you need to, add
pages, numbering them as part of this section.)

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4. Duration of Mental Health Care Directive

Initial A or B.

A._____It is my intention that this advance
directive will remain in effect for an
indefinite period of time. OR

B._____It is my intention that this advance
directive will automatically expire two
years from the date it was executed.

If my choice above is not valid under state law, then it is my intention that this advance directive remain in effect for as long as the law permits.