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The Durable Power of Attorney for Health Care gives your named Attorney-In-Fact the power to make medical decisions, sign consents and /or releases with hospitals and/or doctors in the event you become unable (or incapacitated and are unable) to make decisions for yourself. This form should be used in conjunction with your Living Will. The Health Care Power of Attorney only designates who you want to be your voice and the Living Will expresses your wishes and alone the Health Care Power of Attorney does not express any evidence of your wishes.
- Durable Power of Attorney for Health Care must be notarized.
- Durable Power of Attorney for Health Care is state specific and on average consists of three pages in length.
- Appointment Designation of Agent.
- Appointment Alternative Agent. (optional)
- This Power of Attorney shall take effect upon my incapacity to make my own health care decisions, and shall continue as long as the incapacity lasts or until I revoke it, whichever happens first.
- The powers of my attorney-in-fact under this Power of Attorney are limited to making decisions about my health care on my behalf. These powers shall include the power to order the withholding or withdrawal of life-sustaining treatment if my attorney-in-fact believes, in his or her own judgment, that is what I would want if I could make the decision myself. The existence of this Durable Power of Attorney for Health Care shall have no effect upon the validity of any other Power of Attorney for other purposes that I have executed or may execute in the future.
- In the event that a proceeding is initiated to appoint a guardian of my person under "your state law" shall be cited
- Sign on my behalf any documents necessary to carry out the authorizations described herein, including any waivers or releases of liability required by any health care provider
- Give or withhold consent for my medical care or treatment
- Request, review, and receive, to the extent I could do so individually, any information, verbal or written, regarding my physical or mental health, including, but not limited to, my individually identifiable health information or other medical records.
- Employ and discharge medical personnel for my physical, mental and/or emotional well-being, and authorize reasonable compensation
- Arrange for my placement in or removal from any hospital, convalescent center, hospice or other medical facility
- Revoke, modify or change consent to procedures, tests and treatment as well as hospitalization, convalescent care, hospice or home care which may have previously been allowed or consented to or which may have been provided due to emergency conditions when such procedures, tests or treatments are no longer of benefit to me
- and much more...
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