Statutory Short Form Durable Power of Attorney for Health Care - Georgia

‘GEORGIA STATUTORY SHORT FORM
DURABLE POWER OF ATTORNEY FOR HEALTH CARE’
31-36-10
NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO GIVE THE
PERSON YOU DESIGNATE (YOUR AGENT) BROAD POWERS TO MAKE
HEALTH CARE DECISIONS FOR YOU, INC LUDING POWER TO REQUIRE,
CONSENT TO, OR WITHDRAW ANY TYPE OF PERSONAL CARE OR MEDICAL
TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND T O ADMIT
YOU TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME, OR OTHER
INSTITUTION; BUT NOT INCLUDING PSYCHOSURGERY, STERILIZATION, OR
INVOLUNTARY HOSPITALIZATI ON OR TREATMENT COVE RED BY TITLE 37
OF THE OFFICIAL CODE OF GEORGIA ANNOTATED. THIS FORM DOES NOT
IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS; BUT,
WHEN A POWER IS EXERCISED, YOUR AGENT WILL HAVE TO USE DUE
CARE TO ACT FOR YOUR BENEFIT AND IN AC CORDANCE WITH THIS FORM.
A COURT CAN TAKE AWAY THE POWERS OF YOUR AGENT IF IT FINDS THE
AGENT IS NOT ACTING PROPERLY. YOU MAY NAME COAGENTS AND
SUCCESSOR AGENTS UNDER THIS FORM, BUT YOU MAY NOT NAME A
HEALTH CARE PROVIDER WHO MAY BE DIRECTLY OR INDIRECTLY
INVOLVED IN RENDERING HEALTH CARE TO YOU UNDER THIS POWER.
UNLESS YOU EXPRESSLY LIMIT THE DURATION OF THIS POWER IN THE
MANNER PROVIDED BELOW OR UNTIL YOU REVOKE THIS POWER OR A
COURT ACTING ON YOUR BEHALF TERMI NATES IT, YOUR AGENT MAY
EXERCISE THE POWERS GIVEN IN THIS PO WER THROUGHOUT YOUR
LIFETIME, EVEN AFTER YOU BECOME DI SABLED, INCAPACITATED, OR
INCOMPETENT. THE POWERS YOU GIVE YOUR AGE NT, YOUR RIGHT TO
REVOKE THOSE POWERS, AND THE PENALTIES FOR VIOLATING THE LAW
ARE EXPLAINED MORE FULLY IN CODE SECTIONS 31-36-6, 31-36-9, AND 31-
36-10 OF THE GEORGIA "DURABLE POWER OF ATTORNEY FOR HEALTH
CARE ACT" OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS
FORM). THAT ACT EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM
OF POWER OF ATTORNEY YOU MAY DESIRE. IF THERE IS ANYTHING
ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A
LAWYER TO EXPLAIN IT TO YOU.
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