Durable Power of Attorney for Health Care Example - Idaho

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SECTION II:
DURABLE POWER OF ATTORNEY FOR HEALTH CARE
and Personal Instructions
(IRC Title 39: Ch.45: §39-4508 to §39-4514)
15. INTRODUCTION: This section lets you name a person (called an “agent” or “attorney-in-
fact”) to make health care decisions for you, if you cannot make them for yourself. The
person you name must be at least 18 years of age. Unless you indicate otherwise, the
powers which you may grant through this document include the authority to make health
care decisions, including life-sustaining treatment decisions, as well as other authorities
regarding related affairs. If you have questions, you should seek further counsel and
advice.
Creation of Durable Power of Attorney for Health Care
16. Be it known that I:
Full Legal Name: ______________________________________________________
Date of Birth: _________________________________________________________
Street Address: ________________________________________________________
City: ______________________________ County: __________________________
State: ______________________________ Zip Code: ________________________
~~ Intend by this document to create a durable power of attorney for health care. This
power of attorney shall not be affected by my later disability, incompetency, or incapacity
(as the “principal” herein). I am of sound mind, and state that execution of this document
is voluntary and without duress. Creation of this power of attorney is for the purpose of
designating someone to act as my health care agent (also known as my attorney-in-fact),
to act in my place to make medical decisions for me if I become unable to make them for
myself . It also grants my agent the authority to make all legal and personal care
decisions that I could make for myself, unless otherwise limited in this document. This
designation is effective when, in the opinion of at least one licensed medical doctor who
has personally examined me, I am no longer able make treatment decisions for myself.
By creating this document I revoke any prior power of attorney for health care.
Designation of Health Care Agent:
17. I understand that I am not required to choose an agent, but that I am advised to do so to
ensure that my wishes are fully represented and followed. Therefore:
(initial only one)
_____ I do not want to choose a health care agent at this time (or I have no one
appropriate for the task). However, I instruct that Section I of this document be
recognized as a declaration of my wishes within this Advance Health Care
Directive (proceed now to sign on page 7);
OR,
_____ I do wish to appoint a health care agent. I recognize that, by Idaho law, this person
may not be my treating health care provider nor a non-relative employee of my
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