Prompt Title: Doctor Affidavit: Patient Capacity

Created 1 year ago
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Affidavit of Capacity

I, [Doctor's Full Name], a licensed physician practicing in [State/Country], depose and state as follows:

  1. I have been providing medical care to [Patient's Full Name] since [Date] for [Medical Condition/Reason for Treatment].

  2. Based on my professional assessment, I affirm that the Patient is of sound mind and has the capacity to make his or her own decisions regarding medical care and personal affairs.

  3. I have evaluated the Patient's cognitive function and determined that the Patient possesses the mental capacity to manage his or her own affairs independently.

  4. I have not identified any signs of cognitive impairment or undue influence that would compromise the Patient's capacity.

  5. I am not a relative of the Patient and have no personal or financial interest in the Patient's affairs.

  6. I am providing this affidavit at the Patient's request for the purpose of asserting the Patient's capacity.

  7. I affirm that the information provided herein is true and accurate to the best of my knowledge and professional judgment.

[Doctor's Full Name] [Medical Degree/Title] [Hospital/Clinic Name] [Address] [City, State/Province, Zip/Postal Code] [Date]

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AhmedCo
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