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Click ‘Get Form’ to open the Health Care Power of Attorney in the editor.
Begin by carefully reading all information provided, including definitions that clarify legal and medical terms.
On the first two lines, print your full name and birth date clearly.
Under 'Naming of My Agent,' fill in the name, address, and phone number of the person you appoint as your attorney-in-fact. You may also list alternate agents if desired.
On page five, review the special instructions regarding nutrition and hydration. If you wish to authorize withholding these in a permanently unconscious state, initial where indicated.
Provide any additional instructions or limitations in the designated section. You can attach extra pages if necessary.
Sign and date the form in front of two witnesses or a notary public to ensure its validity. Remember that certain individuals cannot serve as witnesses.
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