The document is called a durable power of attorney for health care dpoa hc.
Durable power of attorney for health care michigan fillable.
Get and sign durable power of attorney for health care michigan fillable 2010 2020 form making decisions regarding my care custody or medical treatment.
Michigan state long term care.
During the many years of debate over this law right to life of michigan took a strong position in defense of patients rights.
Free printable medical health care power of attorney forms.
In this document you should give directions to the person you select as your spokesperson or health care agent or proxy about the full range of care you want.
Page 3 of 7 1 4 agent s obligation.
This power of attorney has effect only if i become unable to participate in treatment decisions.
The fill in the blanks forms at the end of the pamphlet are but one option should you choose to proceed.
The michigan medical power of attorney form is used to designate a patient advocate to make all health care decisions for the principal if they become incapacitated due to illness old age or injury.
The representative may not choose any end of life decisions unless the principal specifically writes in that he or she would like that as an option.
Anyone else who might need to know about your health care decisions for example a spouse a nursing home or a hospital.
The principal and their patient advocate should share similar values as to health care and the advocate should be able to comfortably fulfill the principal s requests when the time comes.
Durable power of attorney if you are doing long term planning and want to plan for the possibility of your incapacity a durable poa can be helpful as it allows someone to take over your affairs when you can no longer handle them yourself.
Adobe pdf ms word docx opendocument signing requirements 700 5501.
To change your durable power of attorney for health care fill out a.
Medical power of attorney allows a person to handle someone else s health care decisions only in the chance that he or she may not be able to think for themselves.
Or fax it to 1 866 894 3101.
Blue cross blue shield of michigan mail code 0400 600 e.
Two 2 witnesses or notary acknowledgment.
You can mail the form to us at.
Questions and answers about advance directives.
Durable power of attorney for health care wp 11479 aug 0 durablepoahealthcare 0810 i of michigan name city hereby appoint patient advocate residing at patient advocate address as my attorney in fact herein called patient advocate with the following power to be exercised.