Welfare Power of Attorney
This Power of Attorney ("the Agreement") is made on this [DATE] by [YOUR NAME], from hereinafter referred to as the "Principal", located at [YOUR COMPANY ADDRESS].
Appointment of Attorney
I, the Principal, do hereby appoint [AGENT'S NAME], located at [AGENT'S ADDRESS], as my attorney-in-fact (“Agent”) to act in my capacity to make any decisions about my welfare and healthcare.
This Welfare Power of Attorney is established to grant authority to the designated agent to make decisions concerning the personal welfare and healthcare of the principal in situations where the principal is unable to make such decisions themselves.
Duties and Authorities Delegated to the Agent
Medical Decision Making: The agent is authorized to make decisions regarding medical treatment, including but not limited to, the administration of medication, surgeries, and other medical procedures deemed necessary for the welfare of the principal.
Healthcare Management: The agent shall have the authority to manage the principal's healthcare needs, including selecting healthcare providers, arranging medical appointments, and accessing medical records as required for informed decision-making.
Living Arrangements: The agent is empowered to make decisions regarding the principal's living arrangements, including selecting appropriate housing, arranging for in-home care services, or transitioning the principal to a care facility if necessary for their welfare.
End-of-Life Care: If end-of-life care decisions need to be made, the agent shall have the authority to make such decisions by the wishes and best interests of the principal, as expressed in this document or through prior discussions.
Financial Management for Healthcare: The agent is authorized to manage financial matters related to the principal's healthcare, including paying medical bills, accessing insurance benefits, and making arrangements for long-term care funding.
Effective and Termination
This Power of Attorney will become effective on the date of signing and will continue until it is revoked by me. Should I become incapacitated, the authority of the Agent under this Power of Attorney will continue until my death.
Revocation of Power of Attorney
I retain the right to revoke this Power of Attorney at any given time, for any reason. Such revocation must be done in writing and be appropriately signed and dated.
Acknowledgment of Principal
I, [YOUR NAME], hereby grant the aforementioned authority to my designated agent, [AGENT'S NAME], to act on my behalf in matters relating to my welfare and healthcare.
[YOUR NAME](Principal)
[DATE]
I, [AGENT NAME], acknowledge that I have read and understood the terms and responsibilities outlined in this Power of Attorney document. I accept the appointment as Agent and agree to act by the instructions and limitations provided herein.
[AGENT'S NAME](Attorney-in-fact)
[DATE]
WITNESS ACKNOWLEDGEMENT
We, the undersigned witnesses, certify that the principal, [YOUR NAME], signed this Welfare Power of Attorney in our presence, and we believe them to be of sound mind and acting of their own free will.
Witness 1:
[Witness 1 full name]
[Date]
Witness 2:
[Witness 2 full name]
[Date]
NOTARY ACKNOWLEDGEMENT
On this [DATE], [YOUR NAME], known to me to be the person whose name is subscribed to the within the instrument, appeared before me, the undersigned, a Notary Public in and for the said county and state, duly commissioned and sworn, and acknowledged that he/she executed the same for the purposes therein contained.
Witness my hand and official seal.
[Notary Public's Name]
My Commission Expires:
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