The Delaware Health Care Power of Attorney Form is used when you want to authorize someone else on your behalf to make health care related decisions. The attorney-in-fact or agent you choose would have the complete authorization of making these decisions on your behalf when you are not capable of making those which has to be certified by the attending physician.
How to Fill the Delaware Health Care Power of Attorney Form
Begin the document by reading the general instructions followed by instructions for health care decisions. After that the principal must specify the end of life instructions for the agent wherein you must choose between the “choice to prolong life” and “choice not to prolong life”. If you choose “choice not to prolong life,” then you also need to specify in detail about the situations in which you want your life not to be prolonged.
The second segment states that in all cases the principal must be given proper medical care necessary to alleviate pain followed by any other specific medical instructions that the principal would like to give can be mentioned in the ‘C’ section of the form.
After that in the second part of the form the principal needs to provide the details of the agent and the alternate agent whom they wish to appoint to represent them in matters related to Healthcare. The details should include their full and legal name (first, middle, last), their complete address with the zip code, home and work phone number. The powers of the Alternate Agent come onto effect only when the primary agent is incapable, unable or unwilling to perform their duties.
The next section includes the authorities that the agent will hold which includes consent to, refuse, or withdraw consent to any and all types of medical care; access to medical records and information; authorize principal’s admission to or discharge from any hospital; contract for any health care related service or facility on principal’s behalf; hire and fire medical, social service, and other support personnel & authorize, or refuse to authorize, any medication or procedure intended to relieve pain.
The next sections state when the agent’s authority to represent the principal becomes effective followed by the agents obligations.
If the principal wishes to make an anatomical gift/s can fill the fourth part of the form wherein the principal must specify which part of the body they wish to gift, to whom they would like to gift it to and for what purpose would they like to gift it for.
Lastly, the document must be signed by the principal followed by their name, address & address. After that the document must also be signed by two witnesses including their name and address, below the statement for the witnesses. If required the document can also be notarized by the notary public.
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Delaware Health Care Power of Attorney Form
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Delaware Health Care Power of Attorney Form