Living will and health care proxy.

Document Outline:

TO MY FAMILY, MY PHYSICIANS, ANY MEDICAL FACILITY HAVING RESPONSIBILITY FOR MY CARE, AND ALL OTHERS CONCERNED WITH MY WELL-BEING OR AFFAIRS:

I, , hereby appoint ... ,

In the event I receive care in ...

This health care proxy shall ...

I do, however, ask that ...

This request is made after careful ...

I direct my health care agent to ....

If my health care agent named above is .... :

I request, but do not direct, that...

I understand that, unless I revoke it, this proxy will remain in effect indefinitely.

IN WITNESS WHEREOF, I have signed this instrument on .

I declare that ... 

Power of Attorney Forms