Durable Power Of Attorney For Health Care Choices & Health Care Choices Directive Page 2
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DURABLE POWER OF ATTORNEy FOR HEALTH CARE & HEALTH CARE DIRECTIVE
By completing this durable power of attorney, I authorize my agent to make all decisions for
me regarding my health care. This includes the power to withdraw any type of health care,
treatment or procedure, even if I may die in the process. I expect my agent to follow my
health care choices directive. My agent has the power to:
Consent, refuse or withdraw consent to artificially supplied nutrition and hydration.
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Make all necessary arrangements for health care on my behalf. This includes admitting
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me to any hospital, psychiatric treatment facility, hospice, nursing home or other health
care facility.
Hire or fire health care personnel on my behalf.
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Request, receive and review my medical and hospital records.
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Take legal action if necessary to do what I have directed.
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Carry out my wishes regarding autopsy and organ donation, and decide what should be
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done with my body.
My agent under this durable power of attorney will not incur any personal financial liability.
The agent also should not be compensated for services performed for me. However, the
agent shall be reimbursed for reasonable expenses that are part of my care.
THIS IS A DURABLE POWER OF ATTORNEY AND THE AUTHORITY OF MY
ATTORNEY IN FACT, WHEN EFFECTIVE, SHALL NOT TERMINATE OR BE VOID
OR VOIDABLE IF I AM OR BECOME DISABLED OR INCAPACITATED OR IN THE
EVENT OF LATER UNCERTAINTY AS TO WHETHER I AM DEAD OR ALIVE.
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LIFE CHOICES
ago.mo.gov
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