Durable Power Of Attorney For Health Care - State Of Georgia printable pdf download

The Halachic Living Will

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

FOR USE IN GEORGIA

The “Halachic Living Will” is designed to help ensure that all medical and post-death decisions made

by others on your behalf will be made in accordance with Jewish law and custom (halacha). The text of this

Halachic Living Will has been approved by attorneys for use in your state as of July, 2005. While we do not

expect that any future change in federal or state laws would materially affect the validity of this document,

you may wish to show it to your own attorney to confirm its effectiveness in subsequent years. You must be

an individual 18 years of age or older who is of sound mind at the time you execute this document.

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INSTRUCTIONS

Please print your name on the first line of the form.

(a)

In section 1, print the name, address, and day and evening telephone numbers of the person

(b)

you wish to designate as your agent to make medical decisions on your behalf if, G-d forbid, you ever

become incapable of making them on your own..

You may also insert the name, address, and telephone numbers of a successor agent to make such

decisions if your main agent is unable, unwilling, or unavailable to make such decisions.

It is recommended that before appointing anyone to serve as your agent or successor agent you should

ascertain that person’s willingness to serve in such capacity. In addition, if you have made arrangements with

a burial society (Chevra Kadisha) for the handling and disposition of your body after death, you may wish to

advise your agents of such arrangements.

Note: Georgia law allows virtually any competent adult (an adult is a person 18 years of age or older)

to serve as an agent. Thus, you may appoint as your agent or successor agent your spouse, adult child, parent

or other adult relative. You may also appoint a non-relative to serve as your agent (or successor agent).

However, you may not appoint as your agent a health care provider who may be directly or indirectly involved

in rendering health care to you under this Durable Power of Attorney for Health Care.

In section 3, please print the name, address, and telephone numbers of the Orthodox Rabbi

(c)

whose guidance you want your agent to follow, should any questions arise as to the requirements of

halacha.

You should then print the name, address, and telephone numbers of the Orthodox Jewish

institution or organization you want your agent to contact for a referral to another Orthodox Rabbi if

the rabbi you have identified is unable, unwilling or unavailable to provide the appropriate consultation and

guidance.

You are, of course, free to insert the name of any Orthodox Rabbi or institution/organization you

would like, but before doing so it is advisable to discuss the matter with the rabbi or institution/organization to

ascertain their competency and willingness to serve in such capacity.

Durable Power Of Attorney For Health Care - State Of Georgia