Section 3.32 Form of Durable Power of Attorney for Health Care Under Chapter 404, RSMo

• Library: Estate Planning 2013 Forms

Durable Power of Attorney for Health Care

of

John Doe

First: Designation of Health Care Agent

I understand that my wishes expressed above [in Health Care Directive] may not cover all aspects of my care. Consequently, there may be a need for someone to accept or refuse any care or treatment for me if I should be unable to express my own wishes. Accordingly, I, John Doe, of ________________ County, Missouri, do hereby appoint

[if one or more to act in succession] _______________________, but if [he/she], for any reason, is not available, then ______________________ my true and lawful Attorney in Fact to exercise powers on my behalf with respect to health and personal care decisions.

[if two or more to act] ___________________ and ____________________ [either of whom is authorized to act alone whether or not the other is available], my true and lawful Attorney in Fact to exercise powers on my behalf with respect to health and personal care decisions. [If any one of the aforenamed persons is, for any reason, not available, the one remaining is authorized to act alone.]

[if three to act] ______________, _____________, and ____________ [any one/two of whom may act alone whether or not the other is/others are available], my true and lawful Attorney in Fact to exercise powers on my behalf with respect to health and personal care decisions. [If any one of the aforenamed persons is, for any reason, not available, the two remaining are authorized to act alone. If any two of the aforenamed persons are, for any reason, not available, the one remaining is authorized to act alone.]

[if four to act] __________, __________, __________, and ___________ [any one/two/three of whom may act alone whether or not the other is/others are available], my true and lawful Attorney in Fact to exercise powers on my behalf with respect to health and personal care decisions. [If any one of the aforenamed persons is, for any reason, not available, any two of the three remaining are authorized to act alone. If any two of the aforenamed persons are, for any reason, not available, the two remaining are authorized to act alone. If any three of the aforenamed persons are, for any reason, not available, the one remaining is authorized to act alone.]

Second: Power of Health Care Attorney in Fact

In exercising the authority herein granted, my Attorney in Fact shall follow my desires as stated herein or as otherwise made known to my Attorney in Fact. In making any decision regarding my health...