Power Of Attorney For Health Care printable pdf download

"NOTICE TO THE INDIVIDUAL SIGNING THE ILLINOIS

STATUTORY SHORT FORM POWER OF ATTORNEY FOR HEALTH CARE

PLEASE READ THIS NOTICE CAREFULLY. The form that you will be signing is a legal

document. It is governed by the Illinois Power of Attorney Act. If there is anything about this

form that you do not understand, you should ask a lawyer to explain it to you.

The purpose of this Power of Attorney is to give your designated "agent" broad powers to

make health care decisions for you, including the power to require, consent to, or withdraw

treatment for any physical or mental condition, and to admit you or discharge you from any

hospital, home, or other institution. You may name successor agents under this form, but you

may not name co-agents.

This form does not impose a duty upon your agent to make such health care decisions, so

it is important that you select an agent who will agree to do this for you and who will make

those decisions as you would wish. It is also important to select an agent whom you trust,

since you are giving that agent control over your medical decision-making, including

end-of-life decisions. Any agent who does act for you has a duty to act in good faith for your

benefit and to use due care, competence, and diligence. He or she must also act in

accordance with the law and with the statements in this form. Your agent must keep a record

of all significant actions taken as your agent.

Unless you specifically limit the period of time that this Power of Attorney will be in effect,

your agent may exercise the powers given to him or her throughout your lifetime, even after

you become disabled. A court, however, can take away the powers of your agent if it finds

that the agent is not acting properly. You may also revoke this Power of Attorney if you wish.

The Powers you give your agent, your right to revoke those powers, and the penalties for

violating the law are explained more fully in Sections 4-5, 4-6, and 4-10(c) of the Illinois

Power of Attorney Act. This form is a part of that law. The "NOTE" paragraphs throughout

this form are instructions.

You are not required to sign this Power of Attorney, but it will not take effect without your

signature. You should not sign it if you do not understand everything in it, and what your

agent will be able to do if you do sign it.

Please put your initials on the following line indicating that you have read this Notice:

......................

(Principal's initials)"

"ILLINOIS STATUTORY SHORT FORM

Power Of Attorney For Health Care