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New Hampshire Durable Medical Power of Attorney Form |
The New Hampshire durable medical power of attorney form legally allows a patient to appoint another person to make decisions regarding a their health care. This is if they are so ill and are now no longer able to decide and can be effective as soon as the document is created or at a time of choosing by the principal. The document requires at least one notary or two witnesses and coincides with the US statutes § 137- J:1 to -J:16.
How to Write
Durable Power Of Attorney For Health Care
The principal must enter their details and the details of any agents.
- Principal`s name.
- Agent`s name.
- Agent`s address.
- Alternative agent`s name.
- Alternative agent`s address.
A. Life Sustaining Treatment
1) The principal must indicate if they wish to receive or withhold life sustaining treatment if they become near death..
- (a) Withhold or withdraw life sustaining treatment.
- (b) Receive life sustaining treatment.
2) The principal must indicate if they wish to receive or withhold life sustaining treatment if they become permanently unconscious, regardless of whether they are near death or not.
- (a) Withhold or withdraw life sustaining treatment.
- (b) Receive life sustaining treatment.
B. Additional Instructions
The principal must enter details of any other preferences they have regarding their medical health care treatment.
Declaration
The principal must state where the original copy of the power of attorney will be kept and state who will have signed copies. Then the principal must sign and date.
Witnesses Or Notary
The witnesses and the notary may enter their details.
- Name of witnesses.
- Address of witnesses.
- County.
- Date.
- Name of notary.
- Date of expiration of commission.
