Durable Power Of Attorney For Health Care - State Of Georgia Page 4
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73.
Ascertaining the Requirements of Jewish Law: In determining the requirements of Jewish law
and custom in connection with this declaration, I direct my agent to consult with the following Orthodox
Rabbi and I ask my agent to follow his guidance:
Rabbi
Name of Rabbi:
____________________________________________________________
Address:
____________________________________________________________
Telephone: Day:
Evening:
________________________________
__________________________
If such Orthodox Rabbi is unable, unwilling or unavailable to provide such consultation and guidance, then I
direct my agent to consult with, and I ask my agent to follow the guidance of, the following Orthodox Rabbi:
Rabbi
Name of Rabbi:
____________________________________________________________
Address
____________________________________________________________
Telephone: Day:
Evening:
_______________________________
_________________________
Cell:
Pager/beeper:
_______________________________
_________________________
If both of these Orthodox Rabbis are unable, unwilling or unavailable to provide such consultation and
guidance, then I direct my agent to consult with, and I ask my agent to follow the guidance of, an Orthodox
Rabbi referred by the following Orthodox Jewish institution or organization:
Organization
Name of Institution/Organization:
________________________________________________________
Address:
________________________________________________________
Telephone: Day:
Evening:
_____________________________
________________________
If such institution or organization is unable, unwilling or unavailable to make such a reference, or if the
Orthodox Rabbi referred by such institution or organization is unable, unwilling or unavailable to provide such
guidance, then I direct my agent to consult with and follow the guidance of an Orthodox Rabbi whose
guidance on issues of Jewish law and custom my agent in good faith believes I would respect and follow.
4.
Direction to Health Care Providers: Any health care provider shall rely upon and carry out the
decisions of my agent, and may assume that such decisions reflect my wishes and were arrived at in
accordance with the procedures set forth in this directive, unless such health care provider shall have good
cause to believe that my agent has not acted in good faith in accordance with my wishes as expressed in this
directive.
If the persons designated in section 1 above as my agent and successor agent are unable, unwilling or
unavailable to serve in such capacity, it is my desire, and I hereby direct, that any health care provider or other
person who will be making health care decisions on my behalf follow the procedures outlined in section 3
above in determining the requirements of Jewish law and custom.
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