DURABLE POWER OF ATTORNEY
FOR HEALTH CARE AND MEDICAL TREATMENT
I, ______________________, of the City of __________________________, State of
Montana do hereby make, constitute, nominate and appoint _________________presently
residing in ______________________, County, State of Montana, as my true and lawful
attorney-in-fact to act for me, and in my place and stead for the purpose of making any and all
decisions regarding my health and, medical care and treatment at any time that I may be, by
reason of physical, mental disability, incompetency or incapacity, incapable of make decisions
on my behalf.
1. I grant said attorney-in-fact complete and full authority to do and perform all
and every act and thing whatsoever requisite, proper and necessary to be done in
the exercise of the rights herein granted, as fully for all intents and purposes as I
might or could do if personally present and able with full power of substitution or
revocation, hereby ratifying and confirming all that said attorney-in-fact shall
lawfully do or cause to be done by virtue of this power of attorney and the rights
and powers granted herein.
2. If, at any time, I am unable to make or communicate decisions concerning my
medical care and treatment, by virtue of physical, mental or emotional disability,
incompetency, incapacity, illness or otherwise, my said attorney-in-fact shall have
the authority to make all health care decisions and all medical care and treatment
decisions for me and on my behalf, including consenting or refusing to consent to
any care, treatment, service or procedure to maintain, diagnose or treat my mental
or physical condition.
3. In the absence of my ability to give directions regarding my health care, it is
my intention that my said attorney-in-fact shall exercise this specific grant of
authority and that such exercise shall be honored by my family, physicians,
nurses, and any other health care provider(s) or facility in which or by which I
may be treated, as a final expression of my legal rights.
4. This power of attorney is durable and will continue to be effective if I become
disabled, incapacitated, or incompetent.
5. This durable power of attorney is effective in any state that I may seek or
receive medical-treatment and health care.
6. I specifically direct all health care providers, including physicians, nurses,
therapists and medical and hospital staff to follow the directions of my attorney-
in-fact and such decisions are superior to and shall take precedence over any