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Alabama Durable Health Care Power of Attorney Form

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The Alabama durable health care power of attorney is a legal document used by the grantor to authorize the attorney-in-fact to make decisions about his/her health care matters.

Alabama Durable Health Care Power of Attorney Form
Alabama Durable Health Care Power of Attorney Form
STATE OF
ALABAMA
)
)
COUNTY OF )
DURABLE HEALTH CARE POWER OF ATTORNEY
KNOW ALL MEN BY THESE PRESENTS THAT I, _________________, of
__________________, City of _____________, County of ___________, Alabama, hereby make,
constitute and appoint ______________________, whose address is
________________________________, to act as my agent or attorney in fact, to make health care
and related personal decisions for me as authorized in this document. Should
___________________________ for any reason be unable or unwilling to act, temporarily or
permanently, then I appoint __________________, of ____________________________. as such
agent/attorney in fact, with the same authority.
By this document I intend to create a durable power of attorney upon, and only during, any period of
incapacity in which, in the opinion of my health care agent/attorney in fact, after consultation with
my health care providers, I am unable to make or communicate a choice regarding a particular health
care decision. This document is intended to complement and supplement any Advance Health Care
Directive and/or Durable Power of Attorney for financial matters that I may have executed or may
execute in the future. It is my desire to receive appropriate medical treatment so long as there is a
reasonable hope of recovery, but I do not want my life artificially extended beyond any reasonable
hope of recovery to a meaningful quality of life and I do not want to prolong the dying process. I do
not intend by this document to authorize or request euthanasia or assisted suicide but to avoid being
unwillingly sustained in a condition that is only a semblance of life; or to be allowed to endure pain
for which there is treatment available, whether or not recovery is possible.
I grant to my agent full power to make decisions for me regarding my health care. In exercising
his/her authority, my agent shall attempt to communicate with me regarding my wishes if I am able
to communicate in any way. If my agent cannot determine the choice I want made, then (s)he shall
make the choice for me based upon what (s)he believes I would do if I were able, or if unable to so
determine, then based upon what (s)he believes to be my best interests. I intend the power given to
be as broad as possible, except for any limitations in my Advance Directives or set out hereinafter.
Accordingly, unless so limited, my agent is authorized:
To consent to, refuse or withdraw consent to any and all types of medical care, treatment, surgical
procedures, diagnostic procedures, medications and use of mechanical or other procedures affecting
bodily functions; including, without limitation, artificial respiration, nutritional support and
hydration, and cardiopulmonary resuscitation;
To have access to and have the right to disclose medical reports, records and information to the
extent that I would myself;
To authorize admission to or discharge from any hospital, residential care or related facility,
even against medical advice;
Untitled Document http://www.law.ua.edu/elderlaw/advance/7print.asp
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Alabama Durable Health Care Power of Attorney Form
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