Health Care Power of Attorney Example - South Carolina

APPENDIX 2
HEALTH CARE POWER OF ATTORNEY
A health care power of attorney executed on or after January 1, 2007 must be substantially
in the following form (S. C. Code Section 62-5-504 (D):
INFORMATION ABOUT THIS DOCUMENT
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
YOU SHOULD KNOW THESE IMPORTANT FACTS:
1. THIS DOCUMENT GIVES THE PERSON YOU NAME AS YOUR AGENT THE
POWER TO MAKE HEALTH CARE DECISIONS FOR YOU IF YOU CANNOT MAKE THE
DECISION FOR YOURSELF. THIS POWER INCLUDES THE POWER TO MAKE
DECISIONS ABOUT LIFE-SUSTAINING TREATMENT. UNLESS YOU STATE
OTHERWISE, YOUR AGENT WILL HAVE THE SAME AUTHORITY TO MAKE
DECISIONS ABOUT YOUR HEALTH CARE AS YOU WOULD HAVE.
2. THIS POWER IS SUBJECT TO ANY LIMITATIONS OR STATEMENTS OF YOUR
DESIRES THAT YOU INCLUDE IN THIS DOCUMENT. YOU M AY STATE IN THIS
DOCUMENT ANY TREATMENT YOU DO NOT DESIRE OR TREATMENT YOU WANT
TO BE SURE YOU RECEIVE. YOUR AGENT WILL BE OBLIGATED TO FOLLOW YOUR
INSTRUCTIONS WHEN MAKING DECISIONS ON YOUR BEHALF. YOU MAY ATTACH
ADDITIONAL PAGES IF YOU NEED MORE SPACE TO COMPLETE THE STATEMENT.
3. AFTER YOU HAVE SIGNED THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE
HEALTH CARE DECISIONS FOR YOURSELF IF YOU ARE MENTALLY COMPETENT
TO DO SO. AFTER YOU HAVE SIGNED THIS DOCUMENT, NO TREATMENT MAY BE
GIVEN TO YOU OR STOPPED OVER YOUR OBJECTION IF YOU ARE MENTALLY
COMPETENT TO MAKE THAT DECISION.
4. YOU HAVE THE RIGHT TO REVOKE THIS DOCUMENT, AND TERMINATE YOUR
AGENT'S AUTHORITY, BY INFORMING EITHER YOUR AGENT OR YOUR HEALTH
CARE PROVIDER ORALLY OR IN WRITING.
5. IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT
UNDERSTAND, YOU SHOULD ASK A SOCIAL WORKER, LAWYER, OR OT HER
PERSON TO EXPLAIN IT TO YOU.
6. THIS POWER OF ATTORNEY WILL NOT BE VALID UNLESS TWO PERSONS SIGN
AS WITNESSES. EACH OF THESE PERSONS MUST EITHER WITNESS YOUR SIGNING
OF THE POWER OF ATTORNEY OR WITNESS YOUR ACKNOWLEDGMENT THAT
THE SIGNATURE ON THE POWER OF ATTORNEY IS YOURS.
THE FOLLOWING PERSONS MAY NOT ACT AS WITNESSES:
Page 1/7
Free Download

Health Care Power of Attorney Example - South Carolina PDF

Favor this template? Just fancy it by voting!
  •  
  •  
  •  
  •  
  •  
(0 Votes)
0.0
Related Forms
  •  
  •  
  •  
  •  
  •  
3 Page(s) | 1087 Views | 3 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 898 Views | 7 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 3157 Views | 61 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 1164 Views | 4 Downloads
  •  
  •  
  •  
  •  
  •  
1 Page(s) | 1955 Views | 25 Downloads