Source: http://livingwillforms.org/ak/alaska-durable-medical-power-attorney-form/
Timestamp: 2018-02-23 06:33:03
Document Index: 630327337

Matched Legal Cases: ['§ 13', 'art 1', 'art 2', 'art 3', 'art 4', 'art 5']

Alaska Durable Medical Power of Attorney Form - Living Will Forms : Living Will Forms
Living Will Forms > Free Alaska Living Will Forms | Advance Health Care Directive > Alaska Durable Medical Power of Attorney Form
The Alaska medical power of attorney form is to formally appoint a person or `Attorney In Fact` to be the nominated decision maker regarding medical health care treatment on the patient`s. This authority would be required if the patient becomes incapacitated to a level where they are no longer coherent or conscious, this could include brain damage or a coma for examples. The document requires at least or two witnesses, one of the witnesses or a notary, this is in accordance with statute§ 13.52.010 – 395. .
Pages 4 – 5. Part 1. Durable Power Of Attorney For Health CAre Decisions
1) Designation Of Agent
2) Agent`s Authority
Page 6. Part 2. (6) End of life decisions.
(7) Other wishes
Page 8. Part 3. Anatomical Gift Of Death (OPTIONAL)
Check Box `A`to give any organs, tissues or other body parts.
Check box `B` to choose specifically the organs, tissues and other body parts to give. Enter names of these.
Check Boxes to describe the specific purposes designated for the anatomical gift upon death.
Check box `C` if an anatomical gift is NOT to be given.
Pages 8 – 9. Part 4. Mental Health Treatment
Check box to either give consent for the administration of certain medicines, also to be named here by the principal or initial to not consent to the administration of certain medicines to be named here by the principal.
Check box either to give consent or to not give consent for the use of electroconvulsive treatment.
Initial either to give consent, includuing the number of days consent can be given for (up to 17 days). Alternatively to not give consent for admission to and retention in facility.
Enter any other mental health wishes or instructions, including conditions or limitations.
Page 10. Part 5. Primaery Physician
14) Signatures
15) Witnesses