DURABLE POWER OF ATTORNEY FOR HEALTH CARE
DISCLOSURE STATEMENT CONCERNING THE DURABLE POWER OF ATTORNEY
FOR HEALTH CARE
DURABLE POWER OF A TTORNEY FOR HEALTH CARE IS AN IMPORT ANT LEGAL
DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THESE
to the extent you state otherwise, The Durable Power of Attorney for Health Care gives
the person you name as your agent the authority to make any and all health care decisions for you in
accordance with your wishes, including your religious and moral beliefs, when you are no longer capable
of making them yourself. Because "health care" means any treatment, service, or procedure to maintain,
diagnose, or treat your physical or mental condition, your agent has the power to make a broad range of
health care decisions for you. Your agent may consent, refuse to consent, or withdraw a consent to
medical treatment and may make decisions about withdrawing or withholding life-sustaining treatment.
Your agent may not consent to voluntary inpatient mental health services, convulsive treatment,
psychosurgery, abortion, or neglect of the principal through the omission of care primarily intended to
provide comfort. A physician must comply with your agent's instructions or allow you to be transferred to
our agent's authority begins when your doctor certifies that you lack the capacity to make health
our agent is obligated to follow your instructions when making decisions on your behalf. Unless
you state otherwise, your agent has the same authority to make decisions about your health care as you
would have had.
t is important that you discuss the Durable Power of Attorney for Health Care with your
physician or other health care provider before you sign to make sure that you understand the nature and
range of decisions that may be made on your behalf. If you do not have a physician, you should talk with
someone else who is knowledgeable about these issues and can answer your questions. You do not need a
lawyer's assistance to complete the Durable Power of Attorney for Health Care, but if there is anything
in it that you do not understand, you should ask a lawyer to explain it to you.
he person you appoint as agent should be someone you know and trust. The person must be 18
years of age or older or a person under 18 years of age who has had the disabilities of minority removed.
If you appoint your health or residential care provider (e.g., your physician or an employee of a home
health agency, hospital, nursing home, or residential care home, other than a relative), that person has to
choose between acting as your agent or as your health or residential care provider; the law does not permit
a person to do both at the same time.
ou should inform the person you appoint that you want the person to be your health care agent.
You should discuss the Durable Power of Attorney for Health Care with your agent and your physician
and give each a signed copy. You should indicate on the document itself the people and institutions who
have signed copies. Your agent is not liable for health care decisions made in good faith on your behalf.
Nrsg EOL Form #2 Revised: December 26, 2002 Page 1 of 5