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January 3, 2022•

Combined Mental Health Advance Directive Declaration and Power of Attorney Form – fill in form

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Mental Health Advance Directive Declaration Form - fill in form

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Harrisburg Office

301 Chestnut Street
Suite 300
Harrisburg, PA 17101
1-800-692-7443 [Voice]
1-877-375-7139 [TDD]
(717) 236-8110 [Voice]
(833) 699-2110 [Fax Toll Free]
(717) 236-0192 [Fax]

Philadelphia Office

1800 JFK Boulevard, Suite 900
Philadelphia, PA 19103
(215) 238-8070 [Voice]
(833) 699-2110 [Fax Toll Free]
(215) 772-3126 [Fax]

Work Incentives Planning
and Assistance (WIPA) – 215-238-8070, ext. 309

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429 Fourth Avenue
Suite 1404
Pittsburgh, PA 15219-1505
(412) 391-5225 [Voice]
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