Protective Durable Power Of Attorney For Health Care Page 4
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8PROTECTIVE DURABLE POWER OF
ATTORNEY FOR HEALTH CARE
1-651-484-1040
PROTECTIVE DURABLE POWER OF ATTORNEY
FOR HEALTH CARE
Document made this ________day of________________________, _____________
(date)
(month)
(year)
CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE
By this document, I intend to create a durable power of attorney for health care in which I
appoint a health care agent (attorney-in-fact) for the purpose of making health care decisions
for me in the event I am unable to make health care decisions for myself due to incapacity and
only for the duration of such incapacity.
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