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ADVANCE HEALTH-CARE DIRECTIVE
You have the right to name someone else to make health-care decisions for you. If you use this form, you may complete or modify all or any part of it. You are free to use a different form.
This form is a power of attorney for health care. It lets you name another individual as agent to make health-care decisions for you if you become incapable of making you own decisions or if you want someone else to make those decisions for you now even though you are still capable. You may name an alternate agent to act for you if your first choice is not willing, able, or reasonably available to make decisions for you. Unless related to you, your agent may not be an owner, operator, or employee of a health-care institution where you are receiving care.
Unless the form you sign limits the authority of your agent, your agent may make all health-care decisions for you. This form has a place for you to limit the authority of your agent. You need not limit the authority of your agent if you wish to rely on your agent for all health-care decisions that may have to be made. If you choose not to limit the authority of your agent, your agent will have the right to:
(a.) Consent or refuse consent to any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect a physical or mental condition;
(b) Select or discharge health-care providers and institutions;
(c) Approve or disapprove diagnostic tests, surgical procedures, programs of medication, and orders not to resuscitate; and
(d) Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care.
After completing this form, sign and date the form at the end and have the form witnessed or notarized. Give a copy of the signed and completed form to your physician, to any other health-care providers you may have, to any health-care institution at which you are receiving care, and to any health-care agents you have named. You should talk to the person you have named as agent to make sure that he or she understands your wishes and is willing to take responsibility.
You have the right to revoke this advance health-care directive or replace this form at any time.
PART 1 - DURABLE POWER OF ATTORNEY FOR HEALTH CARE DECISIONS
. DESIGNATION OF AGENT. I, , designate the following individual as my agent to make health-care decisions for me:
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
NOTICE: Generally you should not appoint any of the following persons as your agent:
(1) your treating physician or health care provider;
(2) an employee of your treating physician or health care provider, unless the person is your relative;
(3) an owner, operator, or employee of your health-care institution, unless the person is your relative;
(4) your residential care provider; or
(5) an employee of your residential care provider, unless the person is your relative.
. AGENT'S AUTHORITY: My agent is authorized to make all health-care decisions for me, decisions to provide, withhold, or withdraw artificial nutrition and hydration, with the following limitations:
. WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE: My agent's authority becomes effective when my primary physician determines that I am unable to make my own health-care decisions unless I mark the following box.
. AGENT'S OBLIGATION: My agent shall make health-care decisions for me in accordance with this document and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health-care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.
. NOMINATION OF GUARDIAN: If a guardian of my person needs to be appointed to me by a court, I nominate the agent designated in this form.
PART 2 - GENERAL PROVISIONS
A. EFFECT OF COPY. A copy of this form has the same effect as the original.
B. HOLD HARMLESS. All persons or entities who in good faith endeavor to carry out the terms and provisions of this document shall not be liable to me, my estate, my heirs or assigns for any damages or claims arising because of their action or inaction based on this document, and my estate shall defend and indemnify them.
C. SEVERABILITY. If any provision of this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.
D. STATEMENT OF INTENTIONS. It is my intent that this document be legally binding and effective. If the law does not recognize this document as legally binding and effective, it is my intent that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period in which I am unable to make such decisions.
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
| Name: |
| Address: |
| , |
| Name: | ________________________________ |
| Address: | ________________________________ |
| ________________________________ |
| ________________________________ |
| Name: |
| Address: |
| , |
| Name: | ________________________________ |
| Address: | ________________________________ |
| ________________________________ |
| ________________________________ |
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It's fast and simple to give or receive the authority you need with a free Hawaii Medical Power of Attorney template from Rocket Lawyer:
This solution, in most cases, will be notably less time-consuming than meeting and hiring a conventional provider. If needed, you can fill out this Medical PoA on behalf of an elderly parent, a spouse, or another family member, and then have them sign once you've drafted it. Please remember that for a Power of Attorney to be valid, the principal must be an adult who is mentally competent when they sign. In the event that the principal is already unable to make their own decisions, a conservatorship could be required. When dealing with such a situation, it is important for you to connect with a lawyer .
Anyone who is over 18 years old should have a Medical Power of Attorney. Though it can be challenging to think about, a day may come when you can no longer make your own medical decisions. Here are a few typical circumstances in which power of attorney would be helpful:
Regardless of whether your Hawaii Medical Power of Attorney has been made in response to an unexpected issue or as part of a forward-looking plan, notarization and/or witnesses often help to protect your agent if someone disputes their privileges.
In discussing the topics of elder care and/or estate planning with legal or medical professionals, you might find that "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" are used together. At the end of the day, they are one and the same. That said, you should keep in mind that it's possible to establish agency over affairs that aren't related to medical care, in which case, "proxy" is not generally used.
Hawaii Medical PoA forms are generally simple, but you or your agent(s) might need legal advice. It can vary depending on whom you ask, but often some attorneys will not even accept requests to review your document if they were not the author. An easier approach to consider is to get help via the Rocket Lawyer On Call® network. If you become a Premium member, you can request advice from an experienced lawyer or ask additional questions about your Medical Power of Attorney. Rocket Lawyer is here to support you.
The fees associated with finding and hiring a traditional lawyer to produce a Medical Power of Attorney might add up to between two hundred and five hundred dollars, depending on your location. Rocket Lawyer can offer much more protection than most other Power of Attorney template websites that you might discover. As a Rocket Lawyer member, you can get up to a 40% discount when hiring an attorney from our Rocket Lawyer attorney network.
Upon finishing a Medical Power of Attorney with the help of Rocket Lawyer, you'll have the ability to view it at any time and place. You are encouraged to take any or all of the following actions related to your document: editing it, downloading it as a Word document or PDF file, printing it out, and signing it. Attached to your Power of Attorney, you will find a set of instructions on what is next after the document is finished. You should ensure that your agent(s), care providers, and other impacted parties get their copy of your fully executed document.
The rules and restrictions will vary by state; however, in Hawaii, your Power of Attorney will need to be acknowledged by a notary public or signed by two witnesses. Witnesses must not be your healthcare provider or an employee of your healthcare provider's facility. At least one of the witnesses should be someone who is not your relative, spouse, adoptee, heir, or any other beneficiary. As a basic standard, witnesses must be 18 years old or older, and none of them should also be named as your PoA agent.
See Hawaii Medical/Healthcare Power of Attorney law: § 327E-3
