Durable Power Of Attorney For Health Care - State Of Georgia (Page 5 of 7) in pdf

Pending contact with the agent and/or Orthodox Rabbi described above, it is my desire, and I hereby direct,

that all health care providers undertake all essential emergency and/or life sustaining measures on my behalf.

Access to Medical Records and Information; HIPAA: My agent is my personal representative, as

such term is defined under the Health Insurance Portability and Accountability Act of 1996 (“HIPAA”), and

accordingly all of my protected health information (as such term is defined under HIPAA) and other medical

records shall be made available to my agent upon request in the same manner as such information and records

would be released and disclosed to me, and my agent shall have and may exercise all of the rights I would

have regarding the use and disclosure of such information and records, as required under HIPAA.

Post-Mortem Decisions: It is also my desire, and I hereby direct, that after my death, all decisions

concerning the handling and disposition of my body be made pursuant to Jewish law and custom as

determined in accordance with strict Orthodox interpretation and tradition. For example, Jewish law generally

requires expeditious burial and imposes special requirements with regard to the preparation of the body for

burial. It is my wish that Jewish law and custom be followed with respect to these matters.

Further, subject to certain limited exceptions, Jewish law generally prohibits the performance of any autopsy

or dissection. It is my wish that Jewish law and custom be followed with respect to such procedures, and with

respect to all other post-mortem matters including the removal and usage of any of my body organs or tissue

for transplantation or any other purposes. I direct that any health care provider in attendance at my death

notify the agent and/or Orthodox Rabbi described above immediately upon my death, in addition to any other

person whose consent by law must be solicited and obtained, prior to the use of any part of my body as an

anatomical gift, so that appropriate decisions and arrangements can be made in accordance with my wishes.

Pending such notification, and unless there is specific authorization by the Orthodox Rabbi consulted in

accordance with the procedures outlined in paragraph 3 above, it is my desire, and I hereby direct, that no

post-mortem procedure be performed on my body.

Incontrovertible Evidence of My Wishes: If, for any reason, this document is deemed not legally

effective as a health care proxy, or if the persons designated in section 1 above as my agent and successor

agent are unable, unwilling or unavailable to serve in such capacity, I declare to my family, my doctor and

anyone else whom it may concern that the wishes I have expressed herein with regard to compliance with

Jewish law and custom should be treated as incontrovertible evidence of my intent and desire with respect to

all health care measures and post-mortem procedures; and that it is my wish that the procedure outlined in

section 3 above should be followed in determining the requirements of Jewish law and custom.

Durable Power Of Attorney For Health Care - State Of Georgia Page 5