Health Care Power of Attorney Form
A healthcare power of attorney form is used by a client when they wish to give an attorney power and authority to handle matters such as making decisions in any health matters in event the client is not in a capacity to make them. The health care power of attorney explains when and how the attorney should act in event of a health issue. The document below is a sample health care power of attorney form.
Sample Health Care Power of Attorney Form
I (Name of client) _____________________, (Address) ___________________ appoint
(Name of lawyer) ____________________________ of
(Address)___________ (4) _______________ as my attorney. I hereby transfer my authority and rights to the undersigned attorney to make decisions on my behalf as far as my health is concerned.
(Description of extent of authority)
The appointed party shall have the rights and powers to make decisions on my behalf as
described by the client as from _________________ and shall act in that capacity them
until___________________ with exception of an extension or prior notice of termination
by either party.
Dated _________________Sign _________________________
The authority in this mater hereby appoints me as the attorney he grants full authority and
power to act on his behalf concerning the described matter as from
________________________in person and in full knowledge.
Sign__________________ Date_____________________
Commission of Expiry _________________________
Category: Power of Attorney forms
