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Durable Power Of Attorney For Health Care (Washington) POA-WA 102 - Legal Forms
| Durable Power Of Attorney For Health Care (Washington) Form. This is a Legal Forms form and can be used in Health Care-Living Wills Power Of Attorney . |
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DURABLE POWER OF ATTORNEY FOR HEALTH CARE pursuant to Washington Revised Code Sec 11.94.010 THIS POWER OF ATTORNEY SHALL NOT BE AFFECTED BY DISABILITY OF THE PRINCIPAL. A principal may authorize his or her attorney-in-fact to provide informed consent for health care decisions on the principal's behalf. If a principal has appointed more than one agent with authority to make mental health treatment decisions in accordance with a directive under chapter 71.32 RCW, to the extent of any conflict, the most recently appointed agent shall be treated as the principal's agent for mental health treatment decisions unless provided otherwise in either appointment. (Name), living in the city of , in the county of , in the State of Washington, designate (name) as my attorney in fact, to act for me in making health care decisions if I become incapacitated. I hereby revoke any and all health care powers of attorney previously granted by me. 1. Alternate Attorney in Fact: (name) fails to act, or is not If for any reason able to act, I designate (name), then (name) as alternate attorneys in fact, to serve in the order named. An attorney in fact may resign by delivering written notice to that effect, in recordable form, to an alternate, successor, or co-attorney in fact. In this Durable Power of Attorney for Health Care, the "attorney in fact" means the then acting attorney in fact. 2. Power to Make Health Care Decisions: My attorney in fact shall have the right to make decisions, and to give informed consent on my behalf, as to my health care, to the extent permitted by law. This authority shall include, but not be limited to, the right to consent to the withholding or withdrawal of life-sustaining treatment which would only prolong artificially the moment of my death and prevent me from dying naturally, in those circumstances in which a physician(s) has/have determined (a) that I am in a permanent unconscious condition, meaning an incurable and irreversible condition I, in which I am medically assessed within reasonable medical judgment as having no reasonable probability of recovery from an irreversible coma or a persistent vegetative state, or (b) that I have a terminal condition, meaning an incurable and irreversible condition caused, by injury, disease or illness, that would within reasonable medical judgment cause death within a reasonable period of time in accordance with accepted medical standards. I also authorize my attorney in fact to make decisions regarding the artificial administration of food and fluids, consistent with any Health Care Directive (living will) I have executed. 3. Effectiveness. This Durable Power of Attorney for Health Care shall become effective upon my incapacity. Incapacity shall include the inability to make health care decisions effectively for reasons such as mental illness, mental deficiency, incompetency, physical illness or disability, advanced age, chronic use of drugs or chronic intoxication. Incapacity may be determined by (a) a court order or (b) a written qualified attending physician. 4. Duration. This Durable Power of Attorney for Health Care becomes effective as provided in Section 3 above and shall remain in effect to the fullest extent permitted by Chapter 11.94 of the Revised Code of Washington, or until revoked or terminated as provided in Section 5 or 6 below. 5. Revocation. This Durable Power of Attorney for Health Care may be revoked, suspended, or terminated by written notice from me to the designated attorney in fact and, if this power has been recorded, by recording this notice in the office where deeds are recorded for real estate located in the County, Washington. 6. Termination. If appointed, my guardian may, with court approval, revoke, suspend, or terminate this Durable Power of Attorney for Health Care. 7. Reliance. Any person dealing with the assigned attorney in fact shall be entitled to rely upon this Durable Power of Attorney for Health Care to carry out my wishes for health care. No one shall deal with this attorney in fact if they know or have written notice of any cancellation, revocation, suspension, or termination of this Durable Power of Attorney for Health Care. Any action so taken, unless otherwise invalid or unenforceable, shall be binding on my relatives or inheritors of my estate. 8. Indemnity. My estate shall hold harmless and indemnify the attorney in fact from all liability for acts or omissions done in good faith. 9. Applicable. The laws of the State of Washington shall govern this Durable Power of Attorney for Health Care. 10. Execution. This Durable Power of Attorney for Health Care is signed on the day of , 20 , to be effective as provided in Section 3 above. Signature of Declarer NOTE: Washington state law does not require a Durable Power of Attorney for Health Care be witnessed or notarized. However, it is recommended that there always be two witnesses and that these witnesses be persons qualified to witness the signing of a Health Care Directive. Such persons are individuals who are not related to the declarer by blood or marriage and who will not be entitled, under any existing will, to any portion of the estate of the declarer. Witnessing and/or notarization is also important as evidence to help confirm the declarer's competence and help assure that the declarer's wishes are carried out should family members of others oppose on the grounds the declarer did not understand what he/she was doing when signing the document. WITNESSES (Date) Witness (print name) Witness (Signature) (Date) Witness (print name) Witness (Signature) Notarization, If Needed: STATE OF WASHINGTON COUNTY OF I certify that I know or have satisfactory evidence that the GRANTOR signed this instrument and acknowledged it to be his/her free and voluntary act for the uses and purposes mentioned in this instrument. Dated this day of , 20 . NOTARY PUBLIC in and for the State of Washington Residing at My commission expires American LegalNet, Inc. © www.FormsWorkFlow.com
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