Free Kaiser Power of Attorney Template
Kaiser Power of Attorney
I, [YOUR NAME], residing at [YOUR ADDRESS], being of sound mind and understanding the implications of this document, do hereby appoint [ATTORNEY'S NAME], residing at [ATTORNEY'S ADDRESS], as my lawful Attorney-in-Fact (hereinafter referred to as "Attorney-in-Fact"), to act on my behalf concerning all matters relating to my healthcare as described below, starting on July 13, 2054.
I. POWERS AND RESPONSIBILITIES
I hereby confer upon my Attorney-in-Fact full power and authority to make decisions concerning any aspect of healthcare, medical treatment, surgical procedures, or admittance to nursing facilities or other medical establishments essential for my well-being, predicated upon the guidance and approval of my attending physicians and other medical personnel. This authority extends to the selection of healthcare providers and facilities, access to medical records, and the formulation of a comprehensive medical treatment plan, restricted within the confines of the Kaiser Permanente healthcare system.
II. TERM
The power of attorney that I am granting will continue to hold its validity for an unlimited, indefinite period, commencing from the date when I append my signature below. This, however, shall be valid unless I distinctly indicate a less lengthy period for its operation or if I elect to officially revoke a power of attorney by penning a written communication to this effect.
III. REVOCATION OF PRIOR POWERS OF ATTORNEY
I hereby nullify any prior durable powers of attorney for healthcare executed before the date of this instrument. Nonetheless, this revocation shall not impair the rights of any individual who has acted in good faith under a prior durable power of attorney or agency before being informed of the revocation.
IV. NOTICE
The act of carrying out this Kaiser Power of Attorney doesn't negate or invalidate any other powers of attorney that are currently active and in effect, which have been previously established between me and the agent whom I have legally designated and appointed.
SIGNATURE OF PRINCIPAL
By affixing my signature below, I am verifying the fact that I comprehend both the objective and the consequences linked to this written document.
[YOUR NAME]
Date: [DATE SIGNED]
SIGNATURE OF ATTORNEY-IN-FACT
I, [ATTORNEY'S NAME], hereby accept the responsibilities and authorities granted to me under this Kaiser Power of Attorney.
[ATTORNEY'S NAME]
Date: [DATE SIGNED]
NOTARY ACKNOWLEDGEMENT
On this 13th day of July in the year 2054, before me, a Notary Public in and for the State of [STATE], personally appeared [YOUR NAME], known to me to be the person whose name is subscribed to the foregoing instrument, and acknowledged that he/she executed the same for the purposes therein contained.
Witness my hand and official seal.
[NOTARY PUBLIC'S NAME]
My Commission Expires: [EXPIRATION DATE]
