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Georgia Statutory Durable Power of Attorney For Health Care

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

Georgia Statutory Durable Power of Attorney For Health Care
Georgia Statutory Durable Power of Attorney For Health Care
Georgia Statutory Short Form
Durable Power of Attorney For Health Care
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, INCLUDING POWER TO REQUIRE,
CONSENT TO, OR WITHDRAW ANY TYPE OF PERSONAL CARE OF MEDICAL TREATMENT FOR ANY PHYSICAL
OR MENTAL CONDITION AND TO ADMIT YOU TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME, OR
OTHER INSTITUTION, BUT NOT INCLUDING PSYCHOSURGERY, STERILIZATION, OR INVOLUNTARY HOSPITAL
OR TREATMENT COVERED 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 ACCORDANCE
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 CO-AGENTS 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 TERMINATES IT, YOUR AGENT MAY EXERCISE THE POWERS GIVEN IN THIS
POWER THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME DISABLED, INCAPACITATED, OR
INCOMPETENT. THE POWERS YOU GIVE YOUR AGENT, 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 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.
DURABLE POWER OF ATTORNEY made this
day of 20 _____ .
1.I,
of , (the city you live in) (the
state you live in) hereby appoint:
Agent’s Name: _______________________________
(Person you are appointing)
Agent’s Address: ______________________________________
______________________________________
Telephone Number (work):
(home):
Relation, if any:
as my attorney in fact (my agent) to act for me and in
my name in any way I could act in person to make any and all decisions for me concerning my personal care, medical
treatment, hospitalization, and health care and to require, withhold or withdraw any type of medical treatment or
procedure, even though my death may ensue. My agent shall have the same access to my medical records that I have,
including the right to disclose the contents to others. My agent shall also have full power to make a disposition of any
part or all of my body for medical purposes, authorize an autopsy of my body, and direct the disposition of my remains.
THE ABOVE GRANT OF POWER IS INTENDED TO BE AS BROAD AS POSSIBLE SO THAT YOUR AGENT WILL
HAVE AUTHORITY TO MAKE ANY DECISION YOU COULD MAKE TO OBTAIN OR TERMINATE ANY TYPE OF
HEALTH CARE, INCLUDING WITHDRAWAL OF NOURISHMENT AND FLUIDS AND OTHER LIFE SUSTAINING
OR DEATH-DELAYING MEASURES, IF YOUR AGENT BELIEVES SUCH ACTION WOULD BE CONSISTENT WITH
YOUR INTENT AND DESIRES. IF YOU WISH TO LIMIT THE SCOPE OF YOUR AGENT’S POWERS OR PRESCRIBE
SPECIAL RULES TO LIMIT THE POWER TO MAKE AN ANATOMICAL GIFT, AUTHORIZE AUTOPSY, OR DISPOSE
OF REMAINS, YOU MAY DO SO IN THE FOLLOWING PARAGRAPHS:
Georgia Statutory Durable Power of Attorney For Health Care
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