{"data":{"id":"us-ok/okla.-stat.-tit.-43a-43a-11-106","jurisdiction":"us-ok","citation":"Okla. Stat. tit. 43A, § 43A-11-106","heading":"Form of advance directive - Designation and authority","body":"of attorney-in-fact.\n\nA. A declaration stating the mental health treatment wishes of\n\nthe declarant executed in accordance with the provisions of this act\n\nshall be substantially in the form provided by subsection E of this\n\nsection.\n\nB. A declarant may designate a capable person eighteen (18)\n\nyears of age or older to act as attorney-in-fact to make mental\n\nhealth treatment decisions. An alternative attorney-in-fact may\n\nalso be designated to act as attorney-in-fact if the original\n\nattorney-in-fact is unable or unwilling to act at any time. An\n\nappointment of an attorney-in-fact shall be substantially in the\n\nform provided by subsection E of this section.\n\nC. An attorney-in-fact who has accepted the appointment in\n\nwriting shall have authority to make decisions, in consultation with\n\nthe attending physician or psychologist, about mental health\n\ntreatment on behalf of the declarant only when the declarant is\n\ncertified as incapable and to require mental health treatment as\n\nprovided by Section 10 of this act.\n\n1. These decisions shall be consistent with any wishes or\n\ninstructions the declarant has expressed in the declaration. If the\n\nwishes or instructions of the declarant are not expressed, the\n\nattorney-in-fact shall act in what the attorney-in-fact believes to\n\nbe in the best interest of the declarant.\n\n2. The attorney-in-fact may consent to inpatient mental health\n\ntreatment on behalf of the declarant if so authorized in the advance\n\ndirective for mental health treatment.\n\nD. An attorney-in-fact may withdraw by giving notice to the\n\ndeclarant. If a declarant is incapable, the attorney-in-fact may\n\nwithdraw by giving notice to the named alternative attorney-in-fact\n\nif any, and if none then to the attending physician or provider.\n\nThe attending physician or provider shall note the withdrawal of the\n\nlast named attorney-in-fact as part of the declarant's medical\n\nrecord.\n\nE. An advance directive for mental health treatment shall be\n\nnotarized and shall be in substantially the following form:\n\nADVANCE DIRECTIVE FOR MENTAL HEALTH TREATMENT\n\nI, _____________________, being of sound mind and eighteen (18)\n\nyears of age or older, willfully and voluntarily make known my\n\nwishes about mental health treatment, by my instructions to others\n\nthrough my advance directive for mental health treatment, or by my\n\nappointment of an attorney-in-fact, or both. I thus do hereby\n\ndeclare:\n\nI. DECLARATION FOR MENTAL HEALTH TREATMENT\n\nIf my attending physician or psychologist and another physician\n\nor psychologist determine that my ability to receive and evaluate\n\ninformation effectively or communicate decisions is impaired to such\n\nan extent that I lack the capacity to refuse or consent to mental\n\nhealth treatment and that mental health treatment is necessary, I\n\ndirect my attending physician or psychologist and other health care\n\nproviders, pursuant to the Advance Directives for Mental Health\n\nTreatment Act, to provide the mental health treatment I have\n\nindicated below by my signature.\n\nI understand that \"mental health treatment\" means convulsive\n\ntreatment, treatment with psychoactive medication, and admission to\n\nand retention in a health care facility for a period up to twenty-\n\neight (28) days.\n\nI direct the following concerning my mental health\n\ncare:___________________________________________________\n\n________________________________________________________________\n\nI further state that this document and the information contained\n\nin it may be released to any requesting licensed mental health\n\nprofessional.\n\n____________________________ ___________________\n\nDeclarant's Signature Date\n\n____________________________ ___________________\n\nWitness 1 Date\n\n____________________________ ___________________\n\nWitness 2 Date\n\nII. APPOINTMENT OF ATTORNEY-IN-FACT\n\nIf my attending physician or psychologist and another physician\n\nor psychologist determine that my ability to receive and evaluate\nhealth\n\nprofessional.\n\n____________________________ ___________________\n\nDeclarant's Signature Date\n\n____________________________ ___________________\n\nWitness 1 Date\n\n____________________________ ___________________\n\nWitness 2 Date\n\nII. APPOINTMENT OF ATTORNEY-IN-FACT\n\nIf my attending physician or psychologist and another physician\n\nor psychologist determine that my ability to receive and evaluate\n\ninformation effectively or communicate decisions is impaired to such\n\nan extent that I lack the capacity to refuse or consent to mental\n\nhealth treatment and that mental health treatment is necessary, I\n\ndirect my attending physician or psychologist and other health care\n\nproviders, pursuant to the Advance Directives for Mental Health\n\nTreatment Act, to follow the instructions of my attorney-in-fact.\n\nI hereby appoint:\n\nNAME _____________________________________\n\nADDRESS __________________________________\n\nTELEPHONE #_______________________________\n\nto act as my attorney-in-fact to make decisions regarding my mental\n\nhealth treatment if I become incapable of giving or withholding\n\ninformed consent for that treatment.\n\nIf the person named above refuses or is unable to act on my\n\nbehalf, or if I revoke that person's authority to act as my\n\nattorney-in-fact, I authorize the following person to act as my\n\nattorney-in-fact:\n\nNAME ______________________________________\n\nADDRESS ___________________________________\n\nTELEPHONE #________________________________\n\nMy attorney-in-fact is authorized to make decisions which are\n\nconsistent with the wishes I have expressed in my declaration. If\n\nmy wishes are not expressed, my attorney-in-fact is to act in what\n\nhe or she believes to be my best interest.\n\n_______________________________________\n\n(Signature of Declarant/Date)\n\nIII. CONFLICTING PROVISION\n\nI understand that if I have completed both a declaration and\n\nhave appointed an attorney-in-fact and if there is a conflict\n\nbetween my attorney-in-fact's decision and my declaration, my\n\ndeclaration shall take precedence unless I indicate otherwise.\n\n____________________ ___________ (signature)\n\nIV. OTHER PROVISIONS\n\na. In the absence of my ability to give directions regarding my\n\nmental health treatment, it is my intention that this advance\n\ndirective for mental health treatment shall be honored by my family\n\nand physicians or psychologists as the expression of my legal right\n\nto consent or to refuse to consent to mental health treatment.\n\nb. This advance directive for mental health treatment shall be\n\nin effect until it is revoked.\n\nc. I understand that I may revoke this advance directive for\n\nmental health treatment at any time.\n\nd. I understand and agree that if I have any prior advance\n\ndirectives for mental health treatment, and if I sign this advance\n\ndirective for mental health treatment, my prior advance directives\n\nfor mental health treatment are revoked.\n\ne. I understand the full importance of this advance directive\n\nfor mental health treatment and I am emotionally and mentally\n\ncompetent to make this advance directive for mental health\n\ntreatment.\n\nSigned this _____ day of__________, 19 __\n\n___________________________________\n\n(Signature)\n\n___________________________________\n\nCity, County and State of Residence\n\nThis advance directive was signed in my presence.\n\n___________________________________\n\n(Signature of Witness)\n\n___________________________________\n\n(Address)\n\n___________________________________\n\n(Signature of Witness)\n\n___________________________________\n\n(Address)","path":["OK Code","Title 43A"],"source_url":"https://www.oklegislature.gov/OK_Statutes/CompleteTitles/os43A.pdf","current_through":"2026-08-14","vintage":"open-us-law v2026.08, retrieved 2026-09-14","retrieved_at":"2026-09-14T18:32:36Z","sha256":"3d57f79e5a627995d255d38b639d267f6960fb679e6660d52bee2cd8050b2c0b","source_id":"us-ok","stale":false,"prev":"us-ok/okla.-stat.-tit.-43a-43a-11-105","next":"us-ok/okla.-stat.-tit.-43a-43a-11-107"},"notice":"GroundRules: Original legal text. Not legal advice."}