Health Care Power Of Attorney Form - South Carolina (Page 2 of 7) in pdf

Health Care Power Of Attorney Form - South Carolina Page 2

A BENEFICIARY OF A LIFE INSURANCE POLICY ON YOUR LIFE.

THE PERSONS NAMED IN THE HEALTH CARE POWER OF ATTORNEY AS YOUR

AGENT OR SUCCESSOR AGENT.

YOUR PHYSICIAN OR AN EMPLOYEE OF YOUR PHYSICIAN.

ANY PERSON WHO WOULD HAVE A CLAIM AGAINST ANY PORTION OF YOUR

ESTATE (PERSONS TO WHOM YOU OWE MONEY).

IF YOU ARE A PATIENT IN A HEALTH FACILITY, NO MORE THAN ONE WITNESS MAY BE

AN EMPLOYEE OF THAT FACILITY.

YOUR AGENT MUST BE A PERSON WHO IS 18 YEARS OLD OR OLDER AND OF SOUND

MIND. IT MAY NOT BE YOUR DOCTOR OR ANY OTHER HEALTH CARE PROVIDER THAT

IS NOW PROVIDING YOU WITH TREATMENT; OR AN EMPLOYEE OF YOUR DOCTOR OR

PROVIDER; OR A SPOUSE OF THE DOCTOR, PROVIDER, OR EMPLOYEE; UNLESS THE

PERSON IS A RELATIVE OF YOURS.

YOU SHOULD INFORM THE PERSON THAT YOU WANT HIM OR HER TO BE YOUR

HEALTH CARE AGENT. YOU SHOULD DISCUSS THIS DOCUMENT WITH YOUR AGENT

AND YOUR PHYSICIAN AND GIVE EACH A SIGNED COPY. IF YOU ARE IN A HEALTH

CARE FACILITY OR A NURSING CARE FACILITY, A COPY OF THIS DOCUMENT SHOULD

BE INCLUDED IN YOUR MEDICAL RECORD.

Page 2 of 7

Health Care Power Of Attorney Form - South Carolina Page 2