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FREE Sample Durable Health Care Power of Attorney for California

FREE Sample Durable Health Care Power of Attorney for California

Ratings: (0)|Views: 1,175|Likes:
Published by Stan Burman
This FREE sample durable power of attorney for health care for California is 5 pages, the 6th page is the Notary Acknowledgment. The health care power of attorney is made pursuant to Division 4.5, Sections 4000-4545 inclusive, of the California Probate Code.

The author is a freelance paralegal who has worked in California and Federal litigation since 1995 and has used this sample for many years. Note that the author is NOT an attorney and no guarantee or warranty is provided.
This FREE sample durable power of attorney for health care for California is 5 pages, the 6th page is the Notary Acknowledgment. The health care power of attorney is made pursuant to Division 4.5, Sections 4000-4545 inclusive, of the California Probate Code.

The author is a freelance paralegal who has worked in California and Federal litigation since 1995 and has used this sample for many years. Note that the author is NOT an attorney and no guarantee or warranty is provided.

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Categories:Types, Research
Published by: Stan Burman on Jan 26, 2010
Copyright:Attribution Non-commercial

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02/15/2014

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To subscribe to my FREE weekly legal newsletter visit http://freeweeklylegalnewsletter.gr8.com/ and enter your email address. !e sure to remove this notice and all other notices before using this document. To view other documents for sale by "egal#ocs$ro visit http://www.scribd.com/"egal#ocs$ro/documents 
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#%R&!"E $'(ER 'F &TT'R)E*F'R +E&"T+ ,&RE
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,RE&T-') 'F #%R&!"E $'(ER 'F &TT'R)E* F'R +E&"T+ ,&RE:
 By this document I, ,________________________________ of  _________________________, intend to create a durable power of attorney for health care under Division 4.5, Sections 4!4545 inclusive, of the "alifornia #robate "ode. $his power of attorney shall not be affected by my subse%uent incapacity.&.
#E-)&T-') 'F +E&"T+ ,&RE &E)T:
I do hereby desi'nate and appoint __________________________________________, as my attorney in fact (referred to in this document as my )a'ent)* to ma+e health care decisions for me as authoried in this document. -or the purposes of this document, )health care decision) means consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or  procedure to maintain, dia'nose, or treat my physical or mental condition. If for any reason,  _________________________, is unable or unwillin' to serve as my attorney in fact, then I do
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hereby desi'nate and appoint __________________________________________, as my attorney in fact to ma+e health care decisions for me as authoried in this document. If for any reason, ________________ is unable or unwillin' to serve as my attorney in fact, then I do hereby desi'nate and appoint _____________________________________, as my attorney in fact to ma+e health care decisions for me as authoried in this document. If for any reason,  ________________________, is unable or unwillin' to serve as my attorney in fact, then I do hereby desi'nate and appoint _____________________________________, as my attorney in fact to ma+e health care decisions for me as authoried in this document..
E)ER&" T&TE0E)T 'F &%T+'R-T* R&)TE#:
Sub/ect to any limitations in this document, I hereby 'rant to my a'ent full power and authority to ma+e health care decisions for me to the same e0tent that I could ma+e such decisions for myself if I had the capacity to do so. In e0ercisin' this authority, my a'ent shall ma+e health care decisions that are consistent with my desires as stated in this document, or (if not inconsistent with my desires as stated in this document* otherwise made +nown to my a'ent, includin', but not limited to, my desires concernin' obtainin', refusin', or withdrawin' life! prolon'in' care, treatment, services, and procedures.4.
T&TE0E)T 'F #E-RE1 $E,-&" $R'2--')1 &)# "-0-T&T-'):
In e0ercisin' the authority under this durable power of attorney for health care, my a'ent shall act consistently with my desires as stated below and is sub/ect to the special provisions and limitations stated below.(a*
T&TE0E)T 'F #E-RE ,'),ER)-) "-FE$R'"')-) TRE&T0E)T1 ER2-,E1 &)# $R',E#%RE:
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I do not want to receive medical treatment that, althou'h sustainin' my life, has the effect of prolon'in' my inevitable death if the burdens of such treatment outwei'h the anticipated  benefits. In ma+in' this decision, my a'ent shall consider the %uality and duration of my remainin' life if such treatment is provided or continued and the relief from pain if such treatment is withheld or withdrawn. t the same time that I am si'nin' this durable power of attorney for health care, I am enterin' my initials in the space immediately below this provision to show that I have read this provision and that it reflects my desires. _______________ 
!E %RE T' 0'#-F* T+E &!'2E E,T-') T' REF"E,T *'%R RE&" (-+E1 #' )'T 3%T %E T+E ('R#-) "-TE# +ERE.
If I should have an incurable in/ury, disease, or illness certified by $23 licensed  physicians to be a terminal condition, and if the application of life!sustainin' procedures would serve only to artificially prolon' the moment of my death, and if my treatin' physician determines that my death is imminent, whether or not life!sustainin' procedures are utilied, then I desire that all life!sustainin' treatment be withheld or removed.
!E %RE T' 0'#-F* T+E &!'2E E,T-') T' REF"E,T *'%R RE&" (-+E1 #' )'T 3%T %E T+E ('R#-) "-TE# +ERE.
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&##-T-')&" T&TE0E)T 'F #E-RE1 $E,-&" $R'2--')1 &)# "-0-T&T-'):
I do not wish to be resuscitated if my %uality of life is so impaired that I would be miserable or a tremendous burden to my family. I would only want to live if recovery to a reasonable %uality of life would be possible. Decisions concernin' life!support are to be made in
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