Notary Public Power of Attorney
I, [Your Name], of [Your Company Name], hereby grant the following powers to my agent, [Agent's Name], of [Agent's Address], following the laws of [State/Country]:
I. Roles and Responsibilities
Healthcare Decision Making: My agent is authorized to make decisions regarding my medical treatment and healthcare if I become incapacitated and unable to communicate my wishes. This authority includes but is not limited to, consenting to or refusing medical treatments, surgeries, medications, and other healthcare interventions on my behalf.
Access to Medical Information: My agent has the right to access my medical records, communicate with healthcare providers, and obtain information about my medical condition, diagnosis, prognosis, and treatment options.
Consultation with Healthcare Professionals: My agent is empowered to consult with healthcare professionals, including physicians, nurses, and other medical personnel, to obtain advice and make informed decisions regarding my healthcare needs.
End-of-Life Decisions: If necessary, my agent is authorized to make decisions regarding life-sustaining treatments, artificial nutrition and hydration, and other end-of-life care options following my wishes and best interests.
Admission to Medical Facilities: My agent has the authority to admit me to hospitals, nursing homes, hospice facilities, or other healthcare institutions for medical treatment and care as deemed necessary.
II. DURATION OF THIS POWER OF ATTORNEY
This Power of Attorney shall become effective on the [DATE] and shall remain in effect until [END DATE] or until I can resume making decisions for myself.
III. REVOCATION OF PRIOR POWER OF ATTORNEY
I revoke any prior medical power of attorney. The authority given to my Agent has precedence over the authority of any other person to act on my behalf.
IV. SIGNATURE AND ACKNOWLEDGEMENT
In Witness Whereof, I have signed this Notary Public Power of Attorney for Healthcare Decisions on [Date].
[YOUR NAME][Principal]
[DATE]
[Agent's Name]
[DATE]
Witness Acknowledgement
I, [Witness's Name], affirm that I am a disinterested witness and witnessed the signing of this Notary Public Power of Attorney for Healthcare Decisions by [Your Name] and [Agent's Name] on [Date].
[Witness Name]
[DATE]
Notary Acknowledgement
On this [Date], before me, a Notary Public in and for said County and State, personally appeared [Your Name] and [Agent's Name], known to me to be the persons whose names are subscribed to the foregoing instrument, and acknowledged that they executed the same for the purposes therein contained.
[Witness Name]
[DATE]
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