Nova Scotia Power of Attorney
I. Appointment of Agent
I, [Your Name], residing at [Your Company Address], hereby appoint [Agent's Full Name], residing at [Agent's Address], as my lawful attorney-in-fact (hereinafter referred to as "Agent") to act on my behalf in making medical decisions if I become unable to do so myself.
II. Authority Granted
I grant my Agent full authority to make any medical decisions on my behalf, including but not limited to:
Consent to or refusal of medical treatments, surgeries, procedures, and medications.
Admission to or discharge from any medical facility, hospital, or care facility.
Access to medical records and information relevant to my medical care.
Selection of healthcare providers and specialists.
Implementation or withdrawal of life-sustaining treatments or procedures, including artificial nutrition and hydration.
III. Duties and Responsibilities of the Agent
In exercising the authority granted herein, my Agent shall:
Make medical decisions under my known wishes, beliefs, and values, as expressed by me directly or through any advance directives, including a living will or healthcare proxy.
Consult with medical professionals and other relevant parties to ensure that decisions made are in my best interests and align with my healthcare goals.
Act with diligence, honesty, and integrity in all matters related to my medical care.
Keep accurate records of all medical decisions made and actions taken on my behalf.
Regularly communicate with my family members, caregivers, and other individuals involved in my healthcare to provide updates and seek input as necessary.
IV. Limitations and Special Instructions
This Power of Attorney specifically excludes the authority to make decisions regarding mental health treatment, unless such authority is expressly granted in a separate document. Additionally, my Agent is not authorized to make decisions that would conflict with applicable laws or regulations governing medical care.
V. Revocation and Termination
I reserve the right to revoke or terminate this Power of Attorney at any time, provided that I am of sound mind and capable of making such a decision. Notice of revocation shall be given to my Agent in writing and to all relevant healthcare providers and institutions.
VI. Signature
In witness whereof, I have hereunto set my hand and seal on this [Date]
Principal:
[Your Name]
Agent:
[Agent's Name]
Witness Acknowledgement
We, the undersigned witness, certify that the Principal named herein signed or acknowledged this Power of Attorney in my presence, and to the best of my knowledge, the Principal is of sound mind and acting voluntarily.
Witness 1:
[WITNESS 1 FULL NAME]
[DATE]
Witness 2:
[WITNESS 2 FULL NAME]
[DATE]
Notary Acknowledgement
State of [State]
County of [County Name]
On this day of , 20, before me, a Notary Public in and for said County and State, personally appeared [Your Name], known to me (or satisfactorily proven) to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
[NOTARY PUBLIC'S NAME]
My Commission Expires:
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