Durable Power Of Attorney For Health Care Page 2
Download a blank fillable Durable Power Of Attorney For Health Care in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Durable Power Of Attorney For Health Care with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
3It is my intent that my family, the medical facility, and any doctors, nurses and other medical
personnel involved in my care not be liable for implementing the decisions of my patient
advocate or honoring wishes expressed in this designation.
Photostatic copies of this document, after it is signed and witnessed, shall have the same legal
force as the original document.
This document is to be treated as a Durable Power of Attorney and shall survive my disability or
incapacity.
This document is signed in the state of
. It is my intent that the laws of the state of
govern all questions concerning its validity, the construction of its provisions and its
enforceability. I also intend that it be applied to the fullest extent possible wherever I may be.
I voluntarily sign this Durable Power of Attorney after careful consideration. I understand its
meaning and accept its consequences.
________________________________________________________________________________________________________________________
(Signature)
(Date)
____________________________________________________________________________________
(Contract Number)
Witnesses:
(A witness shall not sign this Durable Power of Attorney unless the person appears to be of
sound mind and under no duress, fraud or undue influence.)
Names and Addresses of Witnesses:
________________________________________________________________________________________________________________________
(Witness 1 Name)
(
Witness 1 Address)
____________________________________________________________________________________
(Witness 1 Signature)
________________________________________________________________________________________________________________________
(Witness 2 Name)
(Witness 2 Address)
____________________________________________________________________________________
(Witness 2 Signature)
(A witness must be a disinterested individual and may not be the person’s spouse, parent, child,
grandchild, sibling, presumptive heir, known devisee at the time of the witnessing, physician,
patient advocate, an employee of a life or health insurance provider for the patient, an employee
of a health facility that is treating the patient, or an employee of a home for the aged.)
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal