Western Australia Enduring Power of Attorney
1. Appointment of Attorney
I, [Your Name], residing at [Your Address], hereby appoint [Agent's Name], residing at [Agent's Address], as my attorney-in-fact (hereinafter referred to as "Agent") to act on my behalf in making healthcare decisions as described herein. This appointment shall become effective upon my incapacity to make such decisions for myself.
2. Authority Granted to Agent
I grant my Agent full authority to make medical and healthcare decisions on my behalf, including but not limited to:
Consent to or refuse medical treatment, surgery, or other healthcare procedures.
Access and review medical records, reports, and information about my health.
Select healthcare providers and facilities for my treatment and care.
Make decisions regarding life-sustaining treatments, including the use of life support or artificial nutrition and hydration, following my wishes and best interests.
3. Limitations and Instructions
I provide the following limitations and instructions for my Agent:
My Agent shall make decisions based on my known wishes, including any written advance directives or verbal instructions provided by me.
If my wishes are unknown or unclear, my Agent shall act in my best interests, considering my values, beliefs, and quality of life.
My Agent shall consult with healthcare professionals and other individuals involved in my care to make informed decisions.
4. Successor Agents
If my Agent is unable or unwilling to serve, I appoint the following successor agents to act in the order listed:
[Successor Agent 1's Name], residing at [Successor Agent 1's Address].
[Successor Agent 2's Name], residing at [Successor Agent 2's Address].
5. Revocation
I reserve the right to revoke this Enduring Power of Attorney for Healthcare Decisions at any time, provided I am mentally competent to do so. A revocation shall be in writing and delivered to my Agent and any healthcare providers or institutions involved in my care.
Signature
In witness whereof, I have hereunto set my hand and seal this [Date] day of [Month, Year].
[Your Name]
[Date Signed]
Witness Acknowledgement
We, the undersigned witnesses, attest that the Principal named herein signed this Enduring Power of Attorney for Healthcare Decisions in our presence and appeared to execute the same willingly and voluntarily.
Witness 1:
[Witness 1: Full Name]
[Date Signed]
Witness 2:
[Witness 2: Full Name]
[Date Signed]
Notary Acknowledgement
State of Western Australia, [County]
On this [Date] day of [Month, Year], before me, a Notary Public in and for said County and State, personally appeared [Principal's Name], known to me to be the person whose name is subscribed to the preceding instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Witness my hand and official seal:
[Notary Public's Name]
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