How to prepare legal forms (click here)

Durable Power Of Attorney [Type 1]
(Long form - Comprehensive)

KNOW ALL MEN by these presents that I, [name], a resident of [county, state], desiring to execute a Power of Attorney for medical care matters, hereby appoint [name] as my Attorney-in-Fact for me and in my name and place, for my use and benefit, to exercise the powers set out in this Power of Attorney as fully and effectually as I could do if competent, personally present, and acting.

MY ATTORNEY-IN-FACT shall have the following powers with respect to my personal care and medical treatment:

1. Decisions Respecting Medical Treatment.

a. (i) To make any and all decisions respecting my medical treatment, including power to determine when and what treatment or treatments are to be provided and that any treatment or treatments are not to be provided (including that treatments being provided are to be continued or discontinued) when, in my Attorney-in-Fact's judgment, such treatment or treatments are not in my best interest, or pursuant to my wishes as expressed in my Health Care Declaration attached hereto [omitted]. (ii) As medical treatment is defined in a subsequent paragraph, this grant of authority includes, but is not limited to, full power acting on my behalf to determine whether maintenance of respiration, by means of a ventilator or otherwise, and alimentation and hydration by means of physical or surgical intubation, intravenous injection, or otherwise are to be undertaken or, once undertaken, continued or discontinued.

b. To authorize or to decline to authorize my admission to a medical, nursing, residential, or similar facility and to enter into agreements on my behalf for my care.

c. To exercise full power acting on my behalf to authorize or to decline any treatment with respect to which I could if competent take such action when, in my Attorney-in-Fact's judgment, a contrary course would not be in my best interest, taking into account my medical condition at the time, the prognosis for recovery, my wishes as previously expressed to my Attorney-in-Fact, and in my Health Care Declaration, and all other factors that my Attorney-in-Fact deems appropriate.

2. Consents and Waivers. To sign any and all consents required for the provision of medical treatment, and to sign any and all waivers of liability on my behalf to the extent reasonably required by providers to secure their good faith compliance with a decision not to initiate or, once begun, to discontinue any medical treatment.

3. Obtain Information. To request, obtain, receive, and inspect any and all information bearing upon my health and relevant to any determinations to be made respecting my medical treatment, to sign whatever authorizations for release of information may be required by providers or others, and to waive any rights I may have for breach of confidentiality of medical records for release of such information to my Attorney-in-Fact.

4. Legal Action. To retain counsel and to take any and all legal actions on my behalf and in my name, or otherwise as my Attorney-in-Fact deems appropriate, that may be necessary or appropriate to obtain compliance with my wishes as expressed elsewhere or as determined by my Attorney-in-Fact pursuant to this Power of Attorney, including but not limited to action to secure appointment of a conservator, guardian, or committee, to obtain a declaratory judgment, and to seek injunctive relief and damage (actual, exemplary, or punitive).

5. Perform All Acts Necessary. To do and perform all and every act and thing whatsoever required, necessary or appropriate with respect to my medical care and treatment, in exercise or effectuation of the...

(Excerpt)

Premium Contract: Ready to fill-in and print. Instant download only $19.95!