In healthcare, there are times when we need to make tough decisions for our loved ones. This is not intended to be used, just to give you an idea, a thought that might help you in your needs. Please consult an attorney for proper guidance and forms. This is not it.
Health Care Power of Attorney
I, AZFAMILYHEALTH.COM___________, as principal, designate ________________________________________________ as my agent for all matters relating to my health care, including, without limitation, full power to give or refuse consent to all medical, surgical, hospital and related health care. This power of attorney is effective on my inability to make or communicate health care decisions. All of my agent’s actions under this power during any period when I am unable to make or communicate health care decisions or when there is uncertainty whether I am dead or alive have the same effect on my heirs, devisees and personal representatives as if I were alive, competent and acting for myself.
If my agent is unwilling or unable to serve or continue to serve, I hereby appoint AZFAMILYHEALTH.COM________________ as my agent.
I have _____ I have not _____ completed and attached a living will for purposes of providing specific direction to my agent in situations that may occur during any period when I am unable to make or communicate health care decisions or after my death. My agent is directed to implement those choices I have initialed in the living will.
I have _____ I have not _____ completed a pre-hospital medical care directive pursuant to Section 36-3251, Arizona Revised Statutes.
This health care directive is made under section 36-3221, Arizona Revised Statutes, and continues in effect for all who may rely on it except those to whom I have given notice of its revocation.
_____________________________ __________
Signature of Principal Date
Principal’s Address: ____________________________________________________
We at AZ Family Health hope this at least helps in some way.
