Health Care Power Of Attorney (Page 2 of 4) in pdf

information to the extent that I would myself;

To authorize admission to or discharge from any hospital, residential care or

•

related facility, even against medical advice;

To contract for health care or related services, without the agent incurring

•

personal liability therefore;

To hire and fire medical, social service or related personnel responsible for my

•

care;

To authorize or refuse to authorize any medication or procedure to relieve pain,

•

even though such use may lead to temporary discomfort or addiction, or

inadvertently hasten the moment of death;

To make anatomical gifts of part of all of my body for medical purposes,

•

To authorize an autopsy and direct disposition of my remains, to the extent

•

permitted by law, and

To take any other action necessary to effectuate the intent and purpose of this

•

broad grant of powers, including, without limitation, granting any waiver of

release from liability required by any health care provider or related agency, and

To sign any document relative to health care in any way whatsoever and pursuing

•

legal action in my name at the expense of my estate, should that be necessary to

enforce compliance with my wishes as determined by my agent pursuant to the

authority given herein.

Without in any way limiting the broad powers herein granted, I express the hope that,

circumstances permitting, my agent will consult family and friends for their advice and

support in arriving at what may be difficult decisions; but the final decisions shall be that

of my agent.

No person who relies in good faith upon any representation of my agent or successor

agent shall be liable to me, my estate, my heirs or assignees, for recognizing the agent_s

authority. Although no compensation of my agent is contemplated, (s)he shall be entitled

to reimbursement of any and all reasonable expenses incurred as a result of carrying out

any provision of this document.

Invalidity of one or more powers shall not invalidate any others.

I am in full control of my mental faculties and I understand the contents of this document

and the effect of this grant of powers to my agent.

Dated this _____ day of ______________, 201__.

_________________________

,Grantor

WITNESSES

I believe the Grantor to be of sound mind and able to make decisions of this kind. I did

not sign his/her name and I am not the health care agent. I am not related to the Grantor

Health Care Power Of Attorney Page 2

Related Articles

Related forms

Related Categories