Puerto Rico Power of Attorney
Purpose
This Power of Attorney is designed to grant authority to the appointed agent to make medical decisions and communicate with healthcare providers on behalf of the principal in the event of their incapacity.
I. Appointment of Agent
I, [Your Name], residing at [Your Company Address], hereby appoint [Agent's Name], residing at [Agent's Address], as my attorney-in-fact (hereinafter referred to as "Agent"), granting them full authority to act on my behalf in making medical decisions and communicating with healthcare providers if I become incapacitated and unable to make decisions for myself. This authority includes but is not limited to, consenting to or refusing medical treatment, surgical procedures, medication, and other healthcare services deemed necessary by healthcare professionals.
II. Roles and Responsibilities
Medical Decision Making: The Agent is authorized to make medical decisions on my behalf, including decisions regarding medical treatment, surgery, hospitalization, and end-of-life care, under my wishes as expressed in this Power of Attorney or, if my wishes are unknown, in my best interests.
Communication with Healthcare Providers: The Agent is empowered to communicate with healthcare providers, access medical records, and receive medical information concerning my health condition, treatment options, and prognosis.
Consent and Refusal: The Agent has the authority to provide consent or refusal for medical procedures, treatments, and interventions, taking into consideration my values, beliefs, and previously expressed wishes regarding healthcare.
Consultation with Experts: The Agent may consult with medical professionals, specialists, and other healthcare experts as necessary to make informed decisions regarding medical care and treatment.
Documentation and Reporting: The Agent is responsible for maintaining accurate records of medical decisions made, healthcare communications, and any relevant information on my health and medical treatment.
III. Limitations
This Power of Attorney is limited solely to matters concerning my medical care and treatment and does not grant the Agent authority over any other aspects of my affairs, including financial or legal matters unless otherwise specified in a separate power of attorney document.
IV. Governing Law
This Power of Attorney shall be governed by and construed per the laws of Puerto Rico.
V. Duration and Revocation
This Power of Attorney shall remain in effect indefinitely unless revoked by me in writing or by legal means. A revocation shall be effective upon written notice to the Agent and any relevant healthcare providers.
VI. Signature Section
By signing below, I acknowledge that I understand the contents of this Power of Attorney and grant the authority outlined herein to my appointed Agent.
Principal:
[Your Name]
[Date]
Agent:
[Agent's Name]
[Date]
Witness Acknowledgement
We, the undersigned witness, hereby acknowledge that [Your Name] signed this Power of Attorney in my presence and that I believe them to be of sound mind and under no duress or undue influence.
Witness 1:
[WITNESS 1 FULL NAME]
[DATE]
Witness 2:
[WITNESS 2 FULL NAME]
[DATE]
Notary Acknowledgement
On this day of , 20, before me, a Notary Public in and for said county and state personally appeared [Your Name] and [Agent's Name], known to me (or proved to me based on satisfactory evidence) to be the persons whose names are subscribed to the foregoing instrument, and acknowledged to me that they executed the same for the purposes therein contained.
[NOTARY PUBLIC'S NAME]
My Commission Expires:
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