Durable Power Of Attorney For Healthcare Decisions (Page 7 of 8) in pdf

Durable Power Of Attorney For Healthcare Decisions Page 7

I declare under penalty of perjury that I am not related to the principal by blood, marriage, or

adoption, and to the best of my knowledge I am not entitled to any part of the estate of the

principal upon the death of the principal under a will now existing by operation of law.

Witness #1:

Signature: __________________________________________________________________

Print Name: _________________________________________________________________

Residence Address: __________________________________________________________

__________________________________________________________

Date: ______________________________________________________________________

Witness #2:

Signature: __________________________________________________________________

Print Name: _________________________________________________________________

Residence Address: __________________________________________________________

__________________________________________________________

Date: _____________________________________________________________________

COPIES: You should retain an executed copy of this document and give one to your

attorney-in-fact. The Power of Attorney should be available so a copy may be given to your

providers of health care.

Under NRS 449.628, a health care provider is allowed to transfer care of a patient to another

provider if the first provider objects on the basis of conscience to implementation of an

Advance Directive.

Durable Power Of Attorney For Healthcare Decisions Page 7