New Hampshire Power of Attorney
This Power of Attorney is made effective as of [Date], by [Your Name], residing at [Your Company Address], herein referred to as the Principal, and grants power to [Agent's Full Name], residing at [Agent's Address], herein referred to as the Agent.
Purpose
This Power of Attorney is established for the specific purpose of granting authority to the Agent to make healthcare decisions, including consenting to medical treatment or accessing medical records on behalf of the Principal.
Roles and Responsibilities
Medical Decision Making: The Agent shall have the authority to make decisions regarding the Principal's healthcare, including but not limited to, consenting to medical treatment, surgeries, and procedures.
Accessing Medical Records: The Agent shall have the authority to access the Principal's medical records, discuss the Principal's medical condition with healthcare providers, and obtain any necessary information regarding the Principal's health.
Consulting Healthcare Professionals: The Agent shall have the authority to consult with healthcare professionals and make decisions regarding the Principal's healthcare following the Principal's wishes and best interests.
End-of-Life Decisions: If the Principal is unable to communicate their wishes regarding end-of-life care, the Agent shall have the authority to make decisions regarding palliative care, life-sustaining treatments, and other end-of-life matters.
Compliance with Legal Requirements: The Agent shall ensure that all decisions made regarding the Principal's healthcare comply with applicable laws, regulations, and ethical standards.
Duration
This Power of Attorney is designed to remain effective and continue its force and validity until its predefined expiration date of [insert expiration date], unless the Principal, who maintains the ultimate authority and responsibility, chooses to withdraw it prematurely.
Revocation
The Principal has the authority to cancel this Power of Attorney whenever they choose, as long as they inform the Agent in writing.
Governing Law
The interpretation and application of this Power of Attorney shall be regulated and comprehended in strict compliance with and subject to the legal statutes and provisions prevailing in the State of New Hampshire.
Signature
In witness whereof, the Principal has executed this Power of Attorney on the date first above written.
[Principal's Name]
[Date Signed]
[Agent's Name]
[Date Signed]
Witness Acknowledgement
We, the undersigned witnesses, attest that the Principal voluntarily executed this Power of Attorney in our presence and appeared to be of sound mind and under no undue influence.
Witness 1:
[Witness 1: Full Name]
[Date Signed]
Witness 2:
[Witness 2: Full Name]
[Date Signed]
Notary Acknowledgement
State of New Hampshire
County of [insert county]
On this [Date] day of [Day], [Year], before me, a Notary Public, personally appeared [insert Principal's name], known to me (or proved to me based on satisfactory evidence) to be the person whose name is subscribed to the within the instrument and acknowledged that they executed the same for the purposes therein contained.
Witness my hand and official seal:
[Notary Public's Name]
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