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Montana Durable Power of Attorney Form for Health Care

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Montana Durable Power of Attorney Form for Health Care which provides for the appointment of a person to represent the medical interests of another. Unfortunately, there may come a situation when you cannot make your own decisions, whether you are unconscious due to an accident or surgery, or you are mentally incapable of making your own decisions. Having this type of form in place allows someone of your choosing to make decisions involving your health care on your behalf.

Laws – § 50-9-103

Living Will – Give instructions to a hospital of the care a patient would like in the event they should become mentally incapacitated in reference to pain and artificial feeding and breathing assistance.

Durable (Statutory) Power of Attorney – A form which enables an individual to select an agent to make financial decisions on their behalf.

How to Write

1 – The Appointment Of Health Powers May Be Completed Once It is Opened Through This Page

The paperwork which should be used to designate an Agent with Durable Health Care Powers is accessible directly on this page through the buttons below the image. Open and download this form in any of the three formats provided then supply the information it requires. Make sure the Principal has read this form and fully comprehends its Effect of Power.

2 – The First Paragraph Requires Party Definitions

The first paragraph of this document requires several specific items to apply some necessary language. Primarily, this statement will act as an initial statement of the Principal Intent to delegate one or more Authorities to a Health Care Agent.

The first blank space is reserved for the Name of the Principal. The Legal Full Name of the Principal must be presented in this space.

The second blank line, after “…The City Of,” requires the Montana County or City where the Principal lives documented. After the term “…Make, Constitute, Nominate, And Appoint,” enter the Attorney-in-Fact’s Legal Full Name on the first blank line following these words. The final requirement of this paragraph will be the County or City where the Attorney-in-Fact lives. Enter this information on the last blank space.

3 – The Principal Review Of The Authority Description Is Mandatory

The list provided in this document may, of course, be altered by the Principal in certain ways. However, it should be kept in mind the intended Effect of this document may potentially be severely compromised. If the Principal wishes to alter any of the wording in the list items defining the Powers being granted, it is strongly recommended he or she consult with an attorney beforehand.

The first and second items provide the language so the Attorney-in-Fact acting as the Principal’s Health Care Agent the Principal Powers to make any Decisions and take any Actions to act on behalf of the Principal to ensure the Principal receives Medical Care and Treatment (of any kind) he or she desires in the manner the Principal desires. This is a broad scope of Powers which shall include such Health Care Decisions as those involving Mental Health, Physical Trauma, Hospice Care, Treatment Plans etc. when the Principal is unable to make or communicate such decisions. The third, fourth, and fifth items will provide the language required for the Principal’s relations and concerned institutions respect this document’s Power regarding the Principal’s Health Care, even if the Principal is incapacitated, disabled, or rendered incompetent in every state or locality the Principal is located and/or receiving care. The sixth and seventh items shall supply the wording required for Health Care Staff and Providers to accept the Health Care Agent’s Decisions regarding the Principal’s Health Care as the Principal’s Directive as of the signing of this form. The eighth item is optional and will require direct input if it is to be applied. If the Principal has named one or more Successor Health Care Agents to act as a back-up, should the one named in the first paragraph be unable or unwilling to wield these Powers, then use the blank lines labeled “A” and “B” to report the Legal Full Name of each Successor Agent. It should be noted these individuals will have Principal Power assigned them in sequential order. That is the one listed in Item A will be eligible to assume Principal Power immediately upon the Primary Health Care Agent’s inability or unwillingness to act with Principal Power. The one listed in Item B will only be able to assume Power if all other parties are unavailable or unable to wield Power. If the Principal has Special Instructions or Provisions that should apply to the Powers in this document, they may be documented in Item 9 (“Special Instructions”). An attachment may be drafted to continue any information that should be reported here if there is not enough room. Item 10 will require the identity of the individual who may determine if the Principal may make or communicate his or her Decisions concerning Medical Care. Typically, this will be a Physician. Enter the Name of the individual who may determine the Principal’s capabilities (for this document’s purpose) on the blank line supplied in Item 10’s paragraph.

4 – The Dated Signature Of The Principal’s Notarized Signature Will Finalize This Execution

The Principal must record the Two-Digit Calendar Day, the Name of the Month, and the Four-Digit Calendar Year when he or she is signing this document using the three blank spaces after the words “Dated This…”  The Principal must sign his or her Name on the line beneath “Signature Of Principal.” Then, supply his or her Social Security Number using the three appropriately spaced lines following the label “Signature Security Number.”

The next page can only be filled out by the Notary Public viewing this Principal Signing.


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