Durable Power of Attorney Form - Alabama

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your property is distributed at your death. INITIAL the specific authority you
WANT to give your agent.)
_____Create, amend, revoke, or terminate an inter vivos trust, by trust or
applicable law
_____Make a gift to which exceeds the monetary limitations of Section 26-
1A-217 of the Alabama Uniform Power of Attorney Act, but subject to any
special instructions in this power of attorney
_____Create or change rights of survivorship
_____Create or change a beneficiary designation
_____Authorize another person to exercise the authority granted under this
power of attorney
_____Waive the principal's right to be a beneficiary of a joint and survivor
annuity, including a survivor benefit under a retirement plan
_____Exercise fiduciary powers that the principal has authority to delegate
AUTHORITY TO ACCESS HEALTH INFORMATION
My agent MAY NOT do any of the following specific acts for me UNLESS I
have INITIALED the specific authority listed below:
______Arrange for my care at home or by admitting me to an appropriate
facility, and, effective immediately, to serve as my personal
representative as that term is used in 45 CFR 164.502 (commonly
known as “HIPAA privacy regulations”), and to have the same access
to my personal health information as I have myself, including, but not
limited to, viewing and obtaining copies of any and all of my personally
identifiable medical records of any kind whatever, and consulting with
medical providers; and I authorize covered medical Entities to provide
such access and to cooperate with my agent under this document [as
well as any health care agent or proxy I may appoint]; [further, my
agent appointed herein may make medical decisions for me, consistent
with applicable law and with any health care directive I may have in
effect at the time decisions may be needed.] [I do not intend, by this
appointment, to prohibit other family members from access to my
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Durable Power of Attorney Form - Alabama PDF

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