John Doe,   DOB: 01/21/1950

See/download my DNR or POLST

3. If I am lost, confused or cannot remember —
my address and family's phone number are:

• 1234 Main Street Anywhere 92111
• Phone Number: (555) 555-5555


My emergency contact's name, phone number and email is:

• Proxy: Jane Doe (555) 222-1234 jsmith@abc.com
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