Health Care Power Of Attorney (Page 5 of 6) in pdf

If it becomes necessary for a court to appoint a guardian of my person, I nominate the persons designated in Section

1, in the order named, to be the guardian of my person, to serve without bond or security. The guardian shall act

consistently with G.S. 35A-1201(a)(5).

8. Reliance of Third Parties on Health Care Agent.

No person who relies in good faith upon the authority of or any representations by my health care agent

shall be liable to me, my estate, my heirs, successors, assigns, or personal representatives, for actions or

omissions in reliance on that authority or those representations.

The powers conferred on my health care agent by this document may be exercised by my health care

agent alone, and my health care agent's signature or action taken under the authority granted in this

document may be accepted by persons as fully authorized by me and with the same force and effect as if

I were personally present, competent, and acting on my own behalf. All acts performed in good faith by

my health care agent pursuant to this power of attorney are done with my consent and shall have the

same validity and effect as if I were present and exercised the powers myself, and shall inure to the

benefit of and bind me, my estate, my heirs, successors, assigns, and personal representatives. The

authority of my health care agent pursuant to this power of attorney shall be superior to and binding upon

my family, relatives, friends, and others.

9. Miscellaneous Provisions.

Revocation of Prior Powers of Attorney. I revoke any prior health care power of attorney. The preceding

sentence is not intended to revoke any general powers of attorney, some of the provisions of which may

relate to health care; however, this power of attorney shall take precedence over any health care

provisions in any valid general power of attorney I have not revoked.

Jurisdiction, Severability, and Durability. This Health Care Power of Attorney is intended to be valid in

any jurisdiction in which it is presented. The powers delegated under this power of attorney are

severable, so that the invalidity of one or more powers shall not affect any others. This power of attorney

shall not be affected or revoked by my incapacity or mental incompetence.

Health Care Agent Not Liable. My health care agent and my health care agent's estate, heirs, successors,

and assigns are hereby released and forever discharged by me, my estate, my heirs, successors, assigns,

and personal representatives from all liability and from all claims or demands of all kinds arising out of

my health care agent's acts or omissions, except for my health care agent's willful misconduct or gross

negligence.

No Civil or Criminal Liability. No act or omission of my health care agent, or of any other person, entity,

institution, or facility acting in good faith in reliance on the authority of my health care agent pursuant to

this Health Care Power of Attorney shall be considered suicide, nor the cause of my death for any civil or

criminal purposes, nor shall it be considered unprofessional conduct or as lack of professional

competence. Any person, entity, institution, or facility against whom criminal or civil liability is asserted

because of conduct authorized by this Health Care Power of Attorney may interpose this document as a

defense.

Reimbursement. My health care agent shall be entitled to reimbursement for all reasonable expenses

incurred as a result of carrying out any provision of this directive.

By signing here, I indicate that I am mentally alert and competent, fully informed as to the contents of this

document, and understand the full import of this grant of powers to my health care agent.

This the _____ day of ______________, 20____.

___________________________________________(SEAL)

I hereby state that the principal, _______________________, being of sound mind, signed (or directed another to

sign on the principal's behalf) the foregoing health care power of attorney in my presence, and that I am not related

to the principal by blood or marriage, and I would not be entitled to any portion of the estate of the principal under

any existing will or codicil of the principal or as an heir under the Intestate Succession Act, if the principal died on

Health Care Power Of Attorney Page 5

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