California Power of Attorney

This form give you the right to give your own health care instructions. You also have the right to name someone else to make health care decisions for you. This form lets you do either or both of these things. This form (living will) lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. It also lets you express your wishes regarding donation of organs and the designation of your primary physician.

ADDITIONAL INFORMATION ABOUT THIS POWER OF ATTORNEY

THIS FORM COMES IN FOUR PARTS

	PART I is a power of attorney for health care. You can name another individual as agent to make health care decisions for you if you become incapable of making your own decisions . You may also name an alternate agent. Your agent may make ALL health care decisions for you unless you limit his or her authority. You need not limit the authority of your agent if you wish to rely on your agent for all health care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to: 1. Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition. 2. Select or discharge health care providers and institutions. 3. Approve or disapprove diagnostic tests, surgical procedures, and programs of medication. 4. Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation. 5. Make anatomical gifts, authorize an autopsy, and direct disposition of remains.
	PART II of this form (living will) lets you give specific instructions about any aspect of your health care, whether or not you appoint an agent. Choices are provided for you to express your wishes regarding the provision, withholding, or withdrawal of treatment to keep you alive, as well as the provision of pain relief. You may write any additional wishes you desire. You do not have to fill in this part if you are satisfied to allow your agent to determine what is best for you.
	PART III of this form lets you express an intention to donate your bodily organs and tissues following your death.
	PART IV of this form lets you designate a physician to have primary responsibility for your health care.

You should carefully read and follow the witnessing procedure described at the end of this document. This document will not be valid unless you comply with the witnessing procedure.

This power of attorney consists of approximately five pages.

You can designate an agent to act for you in transactions involving real estate; chattels and goods; bonds, shares and commodities; banking; business operations; insurance; estates; claims and litigation; personal relationships and affairs; military benefits; retirement benefits; tax matters and all other matters.

ADDITIONAL INFORMATION ABOUT THIS POWER OF ATTORNEY

Revocation of Power of Attorney

Unless your power of attorney expires by its terms, you have a right to revoke your power of attorney at any time by oral or written notice to your agent. Notice of the revocation should be given to anyone who has knowledge of the agency that may be adversely affected.

Executing and Delivering Your Power of Attorney

After you have printed your power of attorney you must gather two witnesses over eighteen (18) and appear before a notary public for signing. Neither witness may be the agent designated in the power of attorney. You should provide the original to your agent and retain a copy for your files.

This document is approximately three pages in length.

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*ADVANCE HEALTH CARE DIRECTIVE*