Health Care Power Of Attorney

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STATE OF ALABAMA
)
)
COUNTY OF
)
HEALTH CARE POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS THAT I, _________________, of
__________________, City of _____________, County of ___________, Alabama,
hereby make, constitute and appoint ______________________, whose address is
________________________________, to act as my agent or attorney in fact, to make
health care and related personal decisions for me as authorized in this document. Should
___________________________ for any reason be unable or unwilling to act,
temporarily or permanently, then I appoint __________________, of
____________________________. as such agent/attorney in fact, with the same
authority.
By this document I intend to create a durable power of attorney upon, and only during,
any period of incapacity in which, in the opinion of my health care agent/attorney in fact,
after consultation with my health care providers, I am unable to make or communicate a
choice regarding a particular health care decision. This document is intended to
complement and supplement any Advance Health Care Directive and/or Durable Power
of Attorney for financial matters that I may have executed or may execute in the future. It
is my desire to receive appropriate medical treatment so long as there is a reasonable
hope of recovery, but I do not want my life artificially extended beyond any reasonable
hope of recovery to a meaningful quality of life and I do not want to prolong the dying
process. I do not intend by this document to authorize or request euthanasia or assisted
suicide but to avoid being unwillingly sustained in a condition that is only a semblance of
life; or to be allowed to endure pain for which there is treatment available, whether or not
recovery is possible.
I grant to my agent full power to make decisions for me regarding my health care. In
exercising his/her authority, my agent shall attempt to communicate with me regarding
my wishes if I am able to communicate in any way. If my agent cannot determine the
choice I want made, then (s)he shall make the choice for me based upon what (s)he
believes I would do if I were able, or if unable to so determine, then based upon what
(s)he believes to be my best interests. I intend the power given to be as broad as possible,
except for any limitations in my Advance Directives or set out hereinafter. Accordingly,
unless so limited, my agent is authorized:
To consent to, refuse or withdraw consent to any and all types of medical care, treatment,
surgical procedures, diagnostic procedures, medications and use of mechanical or other
procedures affecting bodily functions; including, without limitation, artificial respiration,
nutritional support and hydration, and cardiopulmonary resuscitation;
To have access to and have the right to disclose medical reports, records and

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