Durable Power Of Attorney For Health Care Page 8
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15II. Grants of Authority and Responsibility
With respect to my physical and medical treatment, I am granting to my advocate the authorities and
responsibilities indicated below. Check those you are authorizing and add any additional authorities and
responsibilities below. Use more sheets if necessary.
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Access to and control over my medical records and information.
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Power to employ and discharge physicians, nurses, therapists, and any other care providers, and to pay
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them reasonable compensation
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Power to give informed consent to receiving any medical treatment or diagnostic, surgical,
or therapeutic procedure.
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Power to refuse, or to authorize the discontinuance of, any medical treatment, or diagnostic, surgical, or
therapeutic procedure.
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Power to refuse, or to authorize the discontinuance of, any medical treatment or diagnostic, surgical, or
therapeutic procedure. IN GRANTING THIS POWER, I AUTHORIZE MY ADVOCATE TO MAKE A
DECISION
TO WITHHOLD OR WITHDRAW TREATMENT THAT WOULD ALLOW MY DEATH. IF FURTHER
ACKNOWLEDGE THAT SUCH A DECISION TO WITHHOLD OR WITHDRAW TREATMENT COULD O
WOULD ALLOW MY DEATH. I INSTRUCT MY ADVOCATE IN SECTION III, ON THE NEXT PAGE, AS TO
MY DESIRES REGARDING THE WITHHOLDING OR WITHDRAWAL OF TREATMENT THAT COULD OR
WOULD BRING ABOUT MY DEATH. (If you have checked this item, it is strongly recommended that you
use the optional Section III on the next page to specify your desires.)
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Power to execute waivers, medical authorizations, and such other approval as may be required to
permit
or authorize care which I may need, or to discontinue care that I am receiving.
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