Durable Power Of Attorney For Health Care And Medical Treatment Page 2
Download a blank fillable Durable Power Of Attorney For Health Care And Medical Treatment in PDF format just by clicking the "DOWNLOAD PDF" button.
Open the file in any PDF-viewing software. Adobe Reader or any alternative for Windows or MacOS are required to access and complete fillable content.
Complete Durable Power Of Attorney For Health Care And Medical Treatment with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
Some fillable PDF-files have the option of saving the completed form that contains your own data for later use or sending it out straight away.
ADVERTISEMENT
1
2
36. I specifically direct all health care providers, including physicians, nurses,
therapists and medical and hospital staff to follow the directions of my
attorney-in-fact and such decisions are superior to and shall take precedence
over any decisions made by any member of my family.
7. The rights, powers, and authority of said attorney-in-fact herein granted
shall commence and be in full force and effect immediately.
8. If any agent named by me dies, becomes incompetent, resigns or refuses
to accept the office of agent, I name the following persons (each to act alone
and successively, in the order named) as successor(s) to the agent:
A. _____________________________________________________
B. _____________________________________________________
9. Special instructions: On the following lines I give special instructions
limiting or extending the powers granted to my agent.
_____________________________________________________________
_____________________________________________________________
_____________________________________________________________
10. I hereby designate _________________ to determine whether I am
unable to make or communicate decisions concerning my medical care and
treatment by virtue of my physical, mental, or emotional disability,
incompetency, incapacity, illness or otherwise. This determination will be
provided in writing and attached to this Durable Power of Attorney For
Health Care and Medical Treatment.
Dated this __________ day of _____________, ___________.
Signature of Principal:
____________________________________________
Social Security Number: ___________ - ________ - __________.
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Legal