New Mexico Power Of Attorney For Health Care Will To Live Form printable pdf download

New Mexico Power Of Attorney For Health Care Will To Live Form

New Mexico Power of Attorney for Health Care

WILL TO LIVE FORM

I,________________________________________, reside in __________________ County,

New Mexico.

I appoint:

(Name of agent)________________________________________________________________

(address of agent)_______________________________________________________________

(phone number(s) of agent)________________________________________________________

to serve as my agent for health care decisions.

If the agent above is unable to serve, then I appoint:

(successor agent’s name)_________________________________________________________

(successor’s address)_____________________________________________________________

______________________________________________________________________________

(successor’s phone number)_______________________________________________________

to serve as successor agent in place of the person who is unable to serve.

If neither is able to serve, then I appoint

(successor agent’s name)_________________________________________________________

(successor’s address)_____________________________________________________________

______________________________________________________________________________

(successor’s phone number)_______________________________________________________

to serve as successor agent in place of the persons who are unable to serve.

My agent shall have the power to act in my name, place and stead in any way which I myself

could do, consistent with my directions below, only with respect to decisions regarding

lifesaving and life prolonging medical treatment and decisions relating to medical treatment,

surgical treatment, nursing care, medication, hospitalization, placement in a nursing home or

other facility and home health care.

GENERAL PRESUMPTION FOR LIFE

I direct my health care provider(s) and agent to make health care decisions consistent with my

general desire for the use of medical treatment that would preserve my life, as well as for the use

of medical treatment that can cure, improve, reduce or prevent deterioration in, any physical or

mental condition.

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New Mexico Power Of Attorney For Health Care Will To Live Form