Healthcare Power Of Attorney (Page 3 of 5) in pdf

Principal may have made with any health care providers to restrict access to or disclosure

of Principal’s individually identifiable health information. The authority given Agent has

no expiration date and shall expire only in the event that Principal revokes the authority

in writing and deliver it to Principal’s health care provider.

ARTICLE II

PERSONAL CARE

Principal grants Agent all powers regarding the following personal care matters that I

could exercise on my own behalf, if capable of doing so. My agent may:

2.1

Home Care. Provide for my continued maintenance and support. As nearly as

possible, I desire to maintain my accustomed standard of living. My Agent shall provide

me with a suitable place to live, by maintaining me in my family residence or apartment

(home), paying principal, interest, taxes, insurance and repairs as necessary. My Agent

may retain or discharge domestic servants, attendants, companions, nurses, sitters or

other persons who provide care for me and my home.

My Agent may authorize

purchases of food, clothing, medical care and customary luxuries on my behalf.

2.2

Institutional Care. If recommended by my physician, my Agent may contract for

institutional health care (hospital, retirement facility, nursing home, hospice or other) on

my behalf.

2.3

Religious Needs. Continue my affiliation with my church, keeping me accessible

to its clergy, members or other representatives continuing and renewing any pledge made

by me whether for capital, operations or other purposes, and generally to assist me in

maintaining my church relationships to the extent my health permits.

2.4

Companions and Recreation.

Hire, discharge, direct and compensate such

companions as may be necessary for my health, recreation, travel, and general well-

being.

2.5

Funeral Arrangements.

Arrange and contract for my funeral including

appropriate arrangements and instructions for my funeral service or memorial service,

including purchase of a burial plot or other appropriate disposition of my body. My

Agent shall comply with such known written instructions as I may have or leave.

ARTICLE III

REFUSAL OF MEDICAL TREATMENT

Principal does not wish his/her life prolonged artificially through extraordinary or heroic

means if my condition is terminal. Even over the objection of members of my family, my

Agent may:

3.1

Withdraw or Withhold Life Support. If two licensed physicians (one of whom is

my attending physician) have personally examined me and my attending physician has

Law Offices of Regina Scotto Wedig, LLC

Healthcare POA

Healthcare Power Of Attorney Page 3

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