Power of Attorney for Health Care

What is Durable Power of Attorney for Health Care?

paystubmakers.com Durable Power of Attorney is a document in which you select a trusted person, known as an “agent” or “health care proxy,” to make decisions for you in the event that an accident or illness renders you mentally incapable of acting on your own behalf. The term “durable” means that the document remains in effect until you are incapacitated.

Contact Information

Principal Information

Principal Name:

Principal Address:

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Primary Agent Info

Name of Primary Agent

Address of Primary Agent

Successor Agent Info

Name of Successor Agent

Address of Successor Agent

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Agent Powers

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Access to and control over all medical and personal information.

To execute waivers, medical authorizations and such other documentation that may be required to permit or authorize my medical care or discontinue care.

To make decisions that may allow my death.

To give consent or refusal with respect to any medical care; diagnostic, surgical or therapeutic procedure; or other treatment of any type or nature, including life sustaining treatments such as artificial nutrition and hydration.

To hire or discharge any medical personnel.

Additional Instruction

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Power of Attorney for Health Care

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What is Durable Power of Attorney for Health Care?

Contact Information

Principal Information

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Primary Agent Info

Successor Agent Info

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Agent Powers

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