I. Introduction

I, [Parent's Full Legal Name], residing at [Parent's Address], hereby grant power of attorney to [Your Name], residing at [Your Company Address], to act on my behalf in matters related to my healthcare as outlined below:

II. Healthcare Decisions

My agent shall have the authority to make decisions regarding my healthcare, including but not limited to:

• Consent to or refuse medical treatment, surgery, or other medical procedures.

• Make decisions regarding the administration or withdrawal of life-sustaining treatment if I am incapacitated and unable to communicate my wishes.

• Access my medical records and communicate with healthcare providers on my behalf.

• Arrange for my admission to or discharge from medical facilities.

III. Consultation with Healthcare Professionals

My agent is authorized to consult with healthcare professionals, including doctors, nurses, and other medical personnel, to obtain information and make informed decisions regarding my healthcare.

IV. Release of Information

My agent shall have the authority to release any information necessary for the proper management of my healthcare, including information protected by medical confidentiality laws.

V. Duration of Authority

This power of attorney shall remain in effect indefinitely unless revoked by me in writing. However, if I become incapacitated and unable to revoke this power of attorney, it shall remain in effect until the time of my recovery or death.

VI. Limitations

This power of attorney is limited to matters related to my healthcare and does not grant my agent authority over any other aspect of my life or affairs unless explicitly stated in another legal document.

VII. Revocation

I reserve the right to revoke this power of attorney at any time by providing written notice to my agent and any relevant healthcare providers.

VIII. Reliance on Authority

Any person or entity who receives a copy of this power of attorney may rely upon it and act by its terms without further inquiry.

IX. Governing Law

This power of attorney shall be governed by the laws of [State] in effect at the time of its execution.

In witness whereof, I have executed this Parent Power of Attorney on [Date].

[Parent Full Legal Name]
[Date]

[Your Name]
[Date]

_____________________________________________________________________________________

WITNESS ACKNOWLEDGEMENT

We, the undersigned witnesses, hereby acknowledge that the above-named Principal has signed this Power of Attorney in our presence on the date stated above.

Witness 1:

[Witness 1 full name]

[Date]

Witness 2:

[Witness 2 full name]

[Date]

_____________________________________________________________________________________

NOTARY ACKNOWLEDGEMENT

On this            day of               in the year                , before me, a Notary Public in and for said County and State, personally appeared [Your Name], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that they 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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