Common use of PLEASE READ THIS DOCUMENT CAREFULLY Clause in Contracts

PLEASE READ THIS DOCUMENT CAREFULLY. This is a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement: • Read the agreement and complete this form. • Fill in all blank spaces on this form. • Sign and date form. • Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR. • Mail to: AzHDR – Health Current ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ • Or fax to: ▇▇▇-▇▇▇-▇▇▇▇ • Or email to: ▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Processing time: up to three weeks. Check the applicable box (check only one box per submission): New registration. Replace an advance directive(s) presently in the AzHDR with the new one(s) attached. Replace all documents presently in the registry with the new one(s) attached. Replace only the following document type(s) presently in the registry with the new one(s) attached while leaving the others in place (check all that apply): Living will Health care power of attorney Mental health care power of attorney DNR Add an additional document to my currently stored directive(s). Inactivate my account: Check this box if you do not want your documents to be active in the registry. Change registrant demographic information previously submitted (update your information on this form). Health Current | ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ | ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ P: ▇▇▇-▇▇▇-▇▇▇▇ | F: ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ | ▇▇▇▇▇.▇▇▇

PLEASE READ THIS DOCUMENT CAREFULLY. This is a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement: • Read the agreement and complete this form. • Fill in all blank spaces on this form. • Sign and date form. • Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR. • Mail to: AzHDR – Health Current ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇., ▇▇▇. ▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ • Or fax to: ▇▇▇-▇▇▇-▇▇▇▇ • Or email to: ▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Processing time: up to three weeks. Check the applicable box (check only one box per submission): New registration. Replace an advance directive(s) presently in the AzHDR with the new one(s) attached. Replace all documents presently in the registry with the new one(s) attached. Replace only the following document type(s) presently in the registry with the new one(s) attached while leaving the others in place (check all that apply): Living will Health care power of attorney Mental health care power of attorney DNR Add an additional document to my currently stored directive(s). Inactivate my account: Check this box if you do not want your documents to be active in the registry. Change registrant demographic information previously submitted (update your information on this form). Health Current | ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇., ▇▇▇. ▇▇▇▇ | ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ P: ▇▇▇-▇▇▇-▇▇▇▇ | F: ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ | ▇▇▇▇▇.▇▇▇

PLEASE READ THIS DOCUMENT CAREFULLY. This is a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement: • Read the agreement and complete this form. • Fill in all blank spaces on this form. • Sign and date form. • Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR. • Mail to: AzHDR – Health Current ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇., ▇▇▇. ▇▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ • Or fax to: ▇▇▇-▇▇▇-▇▇▇▇ • Or email to: ▇▇▇▇▇@▇▇▇▇@▇▇▇▇▇▇.▇▇▇ Processing time: up to three weeks. Check the applicable box (check only one box per submission): New registration. Replace an advance directive(s) presently in the AzHDR with the new one(s) attached. Replace all documents presently in the registry with the new one(s) attached. Replace only the following document type(s) presently in the registry with the new one(s) attached while leaving the others in place (check all that apply): Living will Health care power of attorney Mental health care power of attorney DNR Add an additional document to my currently stored directive(s). Inactivate my account: Check this box if you do not want your documents to be active in the registry. Change registrant demographic information previously submitted (update your information on this form). Health Current | ▇▇▇▇ ▇. ▇▇▇▇▇▇▇ ▇▇▇., ▇▇▇. ▇▇▇▇ | ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ P: ▇▇▇-▇▇▇-▇▇▇▇ | F: ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ | ▇▇▇▇▇.▇▇▇

PLEASE READ THIS DOCUMENT CAREFULLY. This is a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement: • Read the agreement and complete this form. • Fill in all blank spaces on this form. • Sign and date form. • Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR. • Mail to: AzHDR – Health Current ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ • Or fax to: ▇▇▇-▇▇▇-▇▇▇▇ • Or email to: ▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ documents@azhdr,org Processing time: up to three weeks. Check the applicable box (check only one box per submission): New registration. Replace an advance directive(s) presently in the AzHDR with the new one(s) attached. Replace all documents presently in the registry with the new one(s) attached. Replace only the following document type(s) presently in the registry with the new one(s) attached while leaving the others in place (check all that apply): Living will Health care power of attorney Mental health care power of attorney DNR Add an additional document to my currently stored directive(s). Inactivate my account: Check this box if you do not want your documents to be active in the registry. Change registrant demographic information previously submitted (update your information on this form). Health Current | ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ | ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ P: ▇▇▇-▇▇▇-▇▇▇▇ | F: ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ | ▇▇▇▇▇.▇▇▇

PLEASE READ THIS DOCUMENT CAREFULLY. This is a legally binding agreement (the “Registration Agreement”) between you (“you” or “your”) and Health Current (“we” or “us”) about your submission of documents to the AzHDR. If the instructions herein are not followed, your form(s) may be rejected. How to complete this Agreement: • Read the agreement and complete this form. • Fill in all blank spaces on this form. • Sign and date form. • Attach a copy of the witnessed or notarized advance directive(s). DO NOT SEND ORIGINALS TO THE AZHDR. • Mail to: AzHDR – Health Current ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ • Or fax to: ▇▇▇-▇▇▇-▇▇▇▇ • Or email to: ▇▇▇▇▇▇▇▇▇@▇▇▇▇▇.▇▇▇ Processing time: up to three weeks. Check the applicable box (check only one box per submission): New registration. Replace an advance directive(s) presently in the AzHDR with the new one(s) attached. Replace all documents presently in the registry with the new one(s) attached. Replace only the following document type(s) presently in the registry with the new one(s) attached while leaving the others in place (check all that apply): Living will Health care power of attorney Mental health care power of attorney DNR Add an additional document to my currently stored directive(s). Inactivate my account: Check this box if you do not want your documents to be active in the registry. Change registrant demographic information previously submitted (update your information on this form). Health Current | ▇▇▇▇ ▇. ▇▇▇ ▇▇., ▇▇▇. ▇▇▇ | ▇▇▇▇▇▇▇, ▇▇ ▇▇▇▇▇ P: ▇▇▇-▇▇▇-▇▇▇▇ | F: ▇▇▇-▇▇▇-▇▇▇▇ | ▇▇▇▇▇@▇▇▇▇▇▇▇▇▇▇▇▇▇.▇▇▇ | ▇▇▇▇▇.▇▇▇