Fillable Louisiana Health Care Power Of Attorney printable pdf download

Louisiana Health Care Power Of Attorney

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LOUISIANA HEALTH CARE POWER OF ATTORNEY

, hereby appoint:

Home Telephone Number

Name

Work Telephone Number

Home Address

City, State

Cell Telephone Number

as my agent to make health-care decisions for me if I become unable to make

my own health care decisions such as the following:

A. Grant, refuse, or withdraw consent on my behalf for any health care

service, treatment or procedure, even though my death may ensue.

B. Talk to health care personnel, get information, have access to medical

records and sign forms necessary to carry out these decisions.

C. Authorize my admission to or discharge from any hospital, nursing home,

residential care, assisted living or similar facility or service.

D. Contract on my behalf for any health-care related services or facility

(without my agent incurring personal financial liability for such contracts) such as

surgery, medical expenses and prescriptions.

E. Make decisions regarding surgery, medical expenses and prescriptions.

If the person named as my agent is not available or is unable to act as my

agent, I appoint the following person(s) to serve in the order listed below: