Create Power of Attorney for Health Care
Principal (You)
Enter your personal information.
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Durable Power of Attorney for Health Care
I, _______________, residing at _______________, _______________ , hereby designate and appoint the following individual as my Agent (Attorney-in-Fact) for health care decisions:
Agent (Attorney-in-Fact for Health Care)
_______________
_______________
_______________
Grant of Authority
I grant my Agent the following powers regarding my health care:
Governing Law
This document shall be governed by the laws of the State of _______________.
IN WITNESS WHEREOF, I have executed this Durable Power of Attorney for Health Care on _______________.
Principal Signature
Name: _______________
Date: _______________
Witness Signature
Name: _______________
Date: _______________