Living Will Forms > Free South Carolina Living Will Forms | Advance Health Care Directive > South Carolina Medical Power of Attorney Form

South Carolina Medical Power of Attorney Form

The South Carolina Medical Power Of Attorney is an official declaration by a patient giving authority over their medical health care to an appointed individual. The patient can give complete authority to the agent or limit their powers by adding their own particular preferences in the documnet. It enables health care decisions to be made when they are no longer able to make these decisions themselves through illnesses like a coma or brain damage. The document is in accordance with US statutes §§62-5-501 to -505 and must have two witnesses and a notary.

How to Write

Health Care Power Of Attorney

The principal must enter their name.

Agent

1. The details of a health care agent and any  alternative health care agents must be entered.

  • Name.
  • Address.
  • Home/Work/Mobile telephone numbers.

 

E. The principal must enter details of any limitations to the powers granted to the agent.

 

Organ Donation

5. The principal must initial the relevant blank field.

  • To make an organ donation.
  • To not make an organ donation.

 

Life Sustaining Treatment

7) The principal must initial one blank field to express their wishes regarding life sustaining treatment.

  • 1) To give the agent authority regarding treatments for relief of pain and extending of life.
  • 2) To withdraw or withhold life sustaining treatment if suffering from and end stage condition, if death is imminent or if permanently unconscious.
  • 3) To prolong life to the greatest extent possible.

 

Tube Feeding

8) The principal must initial one blank field to express their wishes regarding tube feeding.

  • 1) To give the agent authority regarding treatments for relief of pain and extending of life.
  • 2) To withdraw or withhold life sustaining treatment if suffering from and end stage condition, if death is imminent or if permanently unconscious.
  • 3) To prolong life to the greatest extent possible.

 

Administrative Provisions

9) The principal, witnesses and notary must enter their details.

  • Date.
  • Principal`s address.
  • Principal`s signature.
  • Principal`s name.
  • Witnesses signatures.
  • Date.
  • Witnesses name.
  • Witnesses telephone number.
  • Witnesses address.
  • County.
  • Date.
  • Notary`s name.
  • Date of expiration of commission.

 

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