Medical Durable Power Of Attorney For Health Care Decisions Form
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2MEDICAL DURABLE POWER OF ATTORNEY
FOR HEALTH CARE DECISIONS
IMPORTANT INFORMATION ABOUT THE FOLLOWING LEGAL DOCUMENT
Before signing this document, it is very important for you to know and understand these facts:
•
This document gives the person you name as your agent the power to make health care decisions if
you are unable to do so. (These decisions and powers are not limited to terminal conditions and life
support decisions.)
•
After you have signed this document, you still have the right to make health care decisions for your-
self if you are able to do so.
•
You may state in this document any type of treatment that you want to receive or want to avoid. If
you want your agent to make decisions about life sustaining treatment, it is best to so state in your
medical durable power of attorney.
•
You have the right to take away the authority of your agent unless you have been determined to be
incompetent by a court. If you withdraw (revoke) the authority of your agent, it is recommended
that you do so in writing and give copies to all those who received the original document.
•
You should not sign this document unless you understand it. You may wish to talk to others or a
lawyer.
•
The Medical Durable Power of Attorney form in this pamphlet may be used; however, it may not
meet your individual needs. Other medical durable power of attorney forms are acceptable according
to Colorado law. Be sure the form you sign meets your needs.
•
The enclosed Medical Durable Power of Attorney form complies with Colorado law; however, witness,
notary and other requirements vary from state to state. If you should move to another state, be
sure to check that state’s requirements.
Your medical durable power of attorney should contain the following information:
•
The name, address and telephone number of the person you choose as your agent, and your second
choice of agent to act if your first agent is unable to act for you.
•
Any instructions about treatment you do or do not wish to receive such as surgery, chemotherapy,
or life sustaining treatment such as artificial feeding, kidney dialysis or breathing support, etc.
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