DONOR CARD
Signed by the donor and the following two witnesses in the presence of each other,
   
signature of donor donor date of birth
 
date signed city & state
 
witness date
This is a legal document under the Uniform Anatomical Gift Act or similar laws. For further information consult your physician or:
 
Ambulatory Care Center
2041 Georgia Ave., NW
Suite 3100
Washington, DC 20060
 
 
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