Maryland Statutory Form - Limited Power Of Attorney Template Page 13
ADVERTISEMENT
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20Security Act, 42 U.S.C. § 1320d, and applicable regulations in making decisions related
to the past, present, or future payment for the provision of health care consented to by
the principal or anyone authorized under the law of this State to consent to health care
on behalf of the principal
(___) Continue provisions made by the principal for automobiles or other
means of transportation, including registering, licensing, insuring, and replacing the
means of transportation, for the individuals described above
(___) Maintain credit and debit accounts for the convenience of the
individuals described above and open new accounts
(___) Continue payments incidental to the membership or affiliation of the
principal in a religious institution, club, society, order, or other organization or to
continue contributions to those organizations
(NOTE: Authority with respect to personal and family maintenance is
neither dependent on, nor limited by, authority that an agent may or may not have
with respect to gifts under this power of attorney.)
(___) All of the above
K.
Benefits from Governmental Programs or Civil or Military Service
(including any benefit, program, or assistance provided under a statute or regulation
including Social Security, Medicare, and Medicaid) – With respect to this subject, I
authorize my agent to:
(___) Execute vouchers in the name of the principal for allowances and
reimbursements payable by the United States or a foreign government or by a state or
subdivision of a state to the principal, including allowances and reimbursements for
transportation of the individuals described in “J. Personal and Family Maintenance”
above, and for shipment of the household effects of those individuals
(___) Take possession and order the removal and shipment of property of the
principal from a post, warehouse, depot, dock, or other place of storage or safekeeping,
either governmental or private, and execute and deliver a release, voucher, receipt, bill
of lading, shipping ticket, certificate, or other instrument for that purpose
(___) Enroll in, apply for, select, reject, change, amend, or discontinue, on
the principal’s behalf, a benefit or program
(___) Prepare, file, and maintain a claim of the principal for a benefit or
assistance, financial or otherwise, to which the principal may be entitled under a
statute or regulation
(___) Initiate, participate in, submit to alternative dispute resolution, settle,
oppose, or propose or accept a compromise with respect to litigation concerning a benefit
or assistance the principal may be entitled to receive under a statute or regulation
– 13 –
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal