| HB 256 - Temp Hlth Care Placement Decision Maker for an Adult Act; enact |
First Reader Summary
A BILL to amend Title 31 of the Official Code of Georgia
Annotated, relating to health, so as to provide for consent to
admission to or discharge from a health care facility or
placement or transfer to another health care facility or
placement for adults unable to consent; and for other purposes.
| Recorded Votes |
| Vote # |
HV99-847 |
PASS |
02/04/99 |
| House |
Action |
Senate |
| 1/27/99 |
Read 1st Time |
2/5/99 |
| 1/28/99 |
Read 2nd Time |
2/12/99 |
| 2/2/99 |
Favorably Reported |
2/11/99 |
| Sub |
Committee Amend/Sub |
|
| 2/4/99 |
Read 3rd Time |
3/23/99 |
| 2/4/99 |
Passed/Adopted |
3/23/99 |
| CS |
Comm/Floor Amend/Sub |
FA |
| 3/23/99 |
Amend/Sub Disagreed To |
|
| 3/24/99 |
Insists |
3/24/99 |
| 3/24/99 |
Conf Comm Appointed |
3/24/99 |
| 3/24/99 |
Conf Comm Rep Adopted |
3/24/99 |
| 4/12/99 |
Sent to Governor |
|
| 4/27/99 |
Signed by Governor |
|
| 311 |
Act/Veto Number |
|
| 7/1/99/9 |
Effective Date |
|
HB 256 HB 256/AP
H. B. No. 256 (AS PASSED HOUSE AND SENATE)
By: Representatives Martin of the 47th, Bordeaux of the
151st and Allen of the 117th
A BILL TO BE ENTITLED
AN ACT
1- 1 To amend the law concerning guardianships and similar
1- 2 agencies and powers; to amend Chapter 5 of Title 29 of the
1- 3 Official Code of Georgia Annotated, relating to guardians of
1- 4 incapacitated adults, so as to change a provision relating
1- 5 to compensation for guardians ad litem; to provide that the
1- 6 court shall fix a reasonable compensation for a guardian ad
1- 7 litem; to amend Chapter 6 of Title 10 of the Official Code
1- 8 of Georgia Annotated, relating to agency, so as to clarify
1- 9 provisions relating to the effect of the appointment of a
1-10 guardian of the property on a written power of attorney; to
1-11 amend the statutory form for financial power of attorney and
1-12 the explanation of such form for principals to clarify that
1-13 appointment of a guardian of property terminates such
1-14 agency; to clarify that the agency created by the statutory
1-15 form terminates upon the principal's death; to amend Title
1-16 31 of the Official Code of Georgia Annotated, relating to
1-17 health, so as to provide for consent to admission to or
1-18 discharge from a health care facility or placement or
1-19 transfer to another health care facility or placement for
1-20 adults unable to consent; to provide a short title; to
1-21 provide for legislative findings and definitions; to provide
1-22 that the Act does not apply to involuntary examination and
1-23 hospitalization for treatment of mental illness; to provide
1-24 for a physician's certification that an adult is unable to
1-25 consent; to authorize enumerated persons to consent; to
1-26 provide for limitation and expiration of authorization to
1-27 consent; to provide for immunity; to provide for petition to
1-28 the probate court for an order authorizing transfer,
1-29 admission, or discharge; to provide for the contents of the
1-30 petition, venue, and jurisdiction; to provide for affidavits
1-31 by a physician and designated personnel of the discharging
1-32 facility or placement; to provide for orders and copies of
1-33 such orders to the commissioner of human resources; to
1-34 provide for expiration and limitation of such orders; to
1-35 clarify the effect of appointment of a guardian upon a
1-36 durable power of attorney for health care; to provide that a
1-37 health care agency which survives incapacity or incompetency
-1-
2- 1 shall not be revoked solely by the appointment of a guardian
2- 2 or receiver for the principal; to provide that the probate
2- 3 court or superior court may direct a guardian of the person
2- 4 to exercise the powers of the principal under a health care
2- 5 agency; to prohibit an order usurping the authority of an
2- 6 agent known to the proposed guardian without notice and a
2- 7 showing that the agent is acting in a manner inconsistent
2- 8 with the power of attorney; to change a provision relating
2- 9 to the form and content of the notice provision to the
2-10 principal in the statutory health care power of attorney
2-11 form; to provide that notice substantially similar to that
2-12 contained in the form and a power of attorney substantially
2-13 similar to the form have the same meaning and effect as
2-14 prescribed in the chapter; to provide that substantially
2-15 similar forms may include forms from other states; to repeal
2-16 conflicting laws; and for other purposes.
2-17 BE IT ENACTED BY THE GENERAL ASSEMBLY OF GEORGIA:
2-18 SECTION 1.
2-19 Chapter 5 of Title 29 of the Official Code of Georgia
2-20 Annotated, relating to guardians of incapacitated adults, is
2-21 amended by striking in its entirety subsection (f) of Code
2-22 Section 29-5-13, relating to compensation and expenses for
2-23 hearings, and inserting in lieu thereof the following:
2-24 "(f) The guardian ad litem shall receive for each day he
2-25 serves as such the same fee as is paid to witnesses for
2-26 each day in attendance at superior court judge of the
2-27 probate court of the county in which the hearing was held
2-28 shall fix a reasonable fee for the services of the
2-29 guardian ad litem."
2-30 SECTION 2.
2-31 Chapter 6 of Title 10, relating to agency, is amended by
2-32 striking in its entirety Code Section 10-6-36, relating to
2-33 the effect of a principal's incompetency on a power of
2-34 attorney, and inserting in its place the following:
2-35 "10-6-36.
2-36 A written power of attorney, unless expressly providing
2-37 otherwise, shall not be terminated by the incompetency or
2-38 incapacity of the principal. The power to act as an
2-39 attorney in fact for a principal who subsequently becomes
2-40 incompetent or incapacitated shall remain in force until
2-41 such time as a guardian of the property or receiver shall
-2-
3- 1 be appointed for the principal or until some other
3- 2 judicial proceeding shall terminate the power."
3- 3 SECTION 3.
3- 4 Said chapter is further amended by striking in its entirety
3- 5 Section 10-6-141, relating to the explanation for principals
3- 6 of the statutory form for power of attorney, and inserting
3- 7 in its place the following:
3- 8 "10-6-141.
3- 9 The following explanation for principals may be used with
3-10 the Georgia Statutory Form for Financial Power of
3-11 Attorney:
3-12 EXPLANATION FOR PRINCIPALS
3-13 WHAT IS A FINANCIAL POWER OF ATTORNEY?
3-14 This document is called a 'Financial Power of Attorney.'
3-15 It allows you to name one or more persons to help you
3-16 handle your financial affairs. Depending on your
3-17 individual circumstances, you can give this person or
3-18 persons complete or limited power to act on your behalf.
3-19 This document does not give someone the power to make
3-20 medical decisions or personal decisions for you.
3-21 WHAT CAN MY AGENT DO?
3-22 The 'Agent' is the person you give power to handle your
3-23 financial affairs.
3-24 The 'Principal' is you.
3-25 Your decision to use this document is a very important
3-26 one and you should think carefully about what financial
3-27 decisions you want your Agent to make for you. With this
3-28 document, you can give your Agent the right to make all
3-29 financial decisions or only certain, limited decisions.
3-30 For example, you can allow your Agent to handle all your
3-31 financial affairs, including the power to sell, rent, or
3-32 mortgage your home, pay your bills, cash or deposit
3-33 checks, buy and sell your stock, investments, or
3-34 personal items. Or, or you can allow your Agent to
3-35 handle only certain or specific financial affairs such
3-36 as to pay your monthly bills.
3-37 DO I GIVE ALL MY POWERS AWAY?
-3-
4- 1 No. Even with this document, you can still handle your
4- 2 own financial affairs as long as you choose to or are
4- 3 able to.
4- 4 You need to talk to your Agent often about what you want
4- 5 and what he or she is doing for you using the document.
4- 6 If your Agent is not following your instructions or
4- 7 doing what you want, you may cancel or revoke the
4- 8 document and end your Agent's power to act for you.
4- 9 HOW DO I REVOKE MY FINANCIAL POWER OF ATTORNEY?
4-10 You may revoke your financial power of attorney by
4-11 writing a signed and dated revocation of power of
4-12 attorney and giving it to your Agent. You should also
4-13 give it to anyone who has been relying upon the
4-14 financial power of attorney and dealing with your Agent,
4-15 such as your bank and investment institutions.
4-16 Unless you notify all parties dealing with your Agent of
4-17 your revocation, they may continue to deal with your
4-18 Agent. You should contact a lawyer if your Agent
4-19 continues to act after you have revoked the power of
4-20 attorney.
4-21 WHEN DOES MY AGENT'S AUTHORITY END?
4-22 Unless you say in the document when you want your
4-23 Agent's power to end, your document As long as you are
4-24 living, the financial power of attorney will remain in
4-25 effect even if you become incapacitated or unable to
4-26 communicate your wishes unless:
4-27 (1) A guardian is appointed for your property; or
4-28 (2) You include a date or specific occurrence when you
4-29 want your document to be canceled.
4-30 However, upon your death or the death of your Agent or
4-31 successor Agents, the document will be canceled and the
4-32 Agent's power to act for you will end.
4-33 You can also include a date or a specific occurrence
4-34 like your incapacity or illness as the time when you
4-35 want your document to be canceled and your Agent's power
4-36 to act for you to end.
4-37 WHEN DO THE POWERS TAKE EFFECT?
4-38 Depending on your circumstances, you may wish to specify
4-39 an occurrence or a future date for the document to
-4-
5- 1 become effective. Unless you do so, it becomes
5- 2 effective immediately.
5- 3 MUST MY AGENT DO THOSE THINGS I AUTHORIZE?
5- 4 No. But if your Agent accepts this responsibility and
5- 5 agrees to act for you, he or she is required to sign and
5- 6 date the 'Acceptance of Appointment' contained in the
5- 7 financial power of attorney form.
5- 8 HOW DO I COMPLETE THIS DOCUMENT?
5- 9 Both the Principal and the Agent should read the full
5-10 document carefully before initialing or signing. The
5-11 Principal and the Agent should fully understand what
5-12 powers are being granted to the Agent and what
5-13 restrictions, if any, exist.
5-14 Read each paragraph carefully. If you decide to give
5-15 your Agent the power described in the paragraph, initial
5-16 your name at the end of the paragraph.
5-17 If you do not wish to give your Agent the power
5-18 described in a paragraph, strike through and initial the
5-19 paragraph or any line within a paragraph.
5-20 HOW DO I EXECUTE THE DOCUMENT?
5-21 Two adult witnesses must watch you sign your name on the
5-22 document. At least one witness cannot be the
5-23 Principal's spouse or blood relative. After they
5-24 witness you signing your name, the witnesses must sign
5-25 their names.
5-26 This document does not need to be notarized unless real
5-27 property transactions such as leasing, selling, or
5-28 mortgaging of property are authorized.
5-29 THIS DOCUMENT REFLECTS THE WISHES OF THE PRINCIPAL.
5-30 Do not let anyone pressure you into making a financial
5-31 power of attorney, naming an Agent, or granting a power
5-32 unless it is your choice.
5-33 If you do not understand any portion of this document,
5-34 you should ask a lawyer to explain it to you."
5-35 SECTION 4.
5-36 Said chapter is further amended by striking in its entirety
5-37 Code Section 10-6-142, relating to the statutory form for
5-38 financial power of attorney, and inserting in its place a
5-39 new Code section to read as follows:
-5-
6- 1 "10-6-142.
6- 2 The Georgia Statutory Form for Financial Power of Attorney
6- 3 shall be substantially as follows:
6- 4 FINANCIAL POWER OF ATTORNEY
6- 5 County of ________
6- 6 State of Georgia
6- 7 I, _______________________, (hereinafter 'Principal'), a
6- 8 resident of ________ County, Georgia, do hereby constitute
6- 9 and appoint _______________________ my true and lawful
6-10 attorney-in-fact (hereinafter 'Agent') for me and give
6-11 such person the power(s) specified below to act in my
6-12 name, place, and stead in any way which I, myself, could
6-13 do if I were personally present with respect to the
6-14 following matters:
6-15 (Directions: To give the Agent the powers described in
6-16 paragraphs 1 through 13, place your initials on the
6-17 blank line at the end of each paragraph. If you DO NOT
6-18 want to give a power to the Agent, strike through the
6-19 paragraph or a line within the paragraph and place your
6-20 initials beside the stricken paragraph or stricken line.
6-21 The powers described in any paragraph not initialed or
6-22 which has been struck through will not be conveyed to
6-23 the Agent. Both the Principal and the Agent must sign
6-24 their full names at the end of the last paragraph.)
6-25 1. Bank and Credit Union Transactions: To make,
6-26 receive, sign, endorse, execute, acknowledge, deliver,
6-27 and possess checks, drafts, bills of exchange, letters
6-28 of credit, notes, stock certificates, withdrawal
6-29 receipts and deposit instruments relating to accounts or
6-30 deposits in, or certificates of deposit of banks,
6-31 savings and loans, credit unions, or other institutions
6-32 or associations. ______
6-33 2. Payment Transactions: To pay all sums of money, at
6-34 any time or times, that may hereafter be owing by me
6-35 upon any account, bill or exchange, check, draft,
6-36 purchase, contract, note, or trade acceptance made,
6-37 executed, endorsed, accepted, and delivered by me or for
6-38 me in my name, by my Agent. ______
6-39 Note: If you initial paragraph 3 or paragraph 4 which
6-40 follow, a notarized signature will be required on behalf
6-41 of the Principal.
-6-
7- 1 3. Real Property Transactions: To lease, sell,
7- 2 mortgage, purchase, exchange, and acquire, and to agree,
7- 3 bargain, and contract for the lease, sale, purchase,
7- 4 exchange, and acquisition of, and to accept, take,
7- 5 receive, and possess any interest in real property
7- 6 whatsoever, on such terms and conditions, and under such
7- 7 covenants, as my Agent shall deem proper; and to
7- 8 maintain, repair, tear down, alter, rebuild, improve,
7- 9 manage, insure, move, rent, lease, sell, convey, subject
7-10 to liens, mortgages, and security deeds, and in any way
7-11 or manner deal with all or any part of any interest in
7-12 real property whatsoever, including specifically, but
7-13 without limitation, real property lying and being
7-14 situate in the State of Georgia, under such terms and
7-15 conditions, and under such covenants, as my Agent shall
7-16 deem proper and may for all deferred payments accept
7-17 purchase money notes payable to me and secured by
7-18 mortgages or deeds to secure debt, and may from time to
7-19 time collect and cancel any of said notes, mortgages,
7-20 security interests, or deeds to secure debt. ______
7-21 4. Personal Property Transactions: To lease, sell,
7-22 mortgage, purchase, exchange, and acquire, and to agree,
7-23 bargain, and contract for the lease, sale, purchase,
7-24 exchange, and acquisition of, and to accept, take,
7-25 receive, and possess any personal property whatsoever,
7-26 tangible or intangible, or interest thereto, on such
7-27 terms and conditions, and under such covenants, as my
7-28 Agent shall deem proper; and to maintain, repair,
7-29 improve, manage, insure, rent, lease, sell, convey,
7-30 subject to liens or mortgages, or to take any other
7-31 security interests in said property which are recognized
7-32 under the Uniform Commercial Code as adopted at that
7-33 time under the laws of Georgia or any applicable state,
7-34 or otherwise hypothecate, and in any way or manner deal
7-35 with all or any part of any real or personal property
7-36 whatsoever, tangible or intangible, or any interest
7-37 therein, that I own at the time of execution or may
7-38 thereafter acquire, under such terms and conditions, and
7-39 under such covenants, as my Agent shall deem proper.
7-40 ______
7-41 5. Stock and Bond Transactions: To purchase, sell,
7-42 exchange, surrender, assign, redeem, vote at any
7-43 meeting, or otherwise transfer any and all shares of
7-44 stock, bonds, or other securities in any business,
7-45 association, corporation, partnership, or other legal
-7-
8- 1 entity, whether private or public, now or hereafter
8- 2 belonging to me. ______
8- 3 6. Safe Deposits: To have free access at any time or
8- 4 times to any safe deposit box or vault to which I might
8- 5 have access. ______
8- 6 7. Borrowing: To borrow from time to time such sums of
8- 7 money as my Agent may deem proper and execute promissory
8- 8 notes, security deeds or agreements, financing
8- 9 statements, or other security instruments in such form
8-10 as the lender may request and renew said notes and
8-11 security instruments from time to time in whole or in
8-12 part. ______
8-13 8. Business Operating Transactions: To conduct, engage
8-14 in, and otherwise transact the affairs of any and all
8-15 lawful business ventures of whatever nature or kind that
8-16 I may now or hereafter be involved in. ______
8-17 9. Insurance Transactions: To exercise or perform any
8-18 act, power, duty, right, or obligation, in regard to any
8-19 contract of life, accident, health, disability,
8-20 liability, or other type of insurance or any combination
8-21 of insurance; and to procure new or additional contracts
8-22 of insurance for me and to designate the beneficiary of
8-23 same; provided, however, that my Agent cannot designate
8-24 himself or herself as beneficiary of any such insurance
8-25 contracts. ______
8-26 10. Disputes and Proceedings: To commence, prosecute,
8-27 discontinue, or defend all actions or other legal
8-28 proceedings touching my property, real or personal, or
8-29 any part thereof, or touching any matter in which I or
8-30 my property, real or personal, may be in any way
8-31 concerned. To defend, settle, adjust, make allowances,
8-32 compound, submit to arbitration, and compromise all
8-33 accounts, reckonings, claims, and demands whatsoever
8-34 that now are, or hereafter shall be, pending between me
8-35 and any person, firm, corporation, or other legal
8-36 entity, in such manner and in all respects as my Agent
8-37 shall deem proper. ______
8-38 11. Hiring Representatives: To hire accountants,
8-39 attorneys at law, consultants, clerks, physicians,
8-40 nurses, agents, servants, workmen, and others and to
8-41 remove them, and to appoint others in their place, and
8-42 to pay and allow the persons so employed such salaries,
-8-
9- 1 wages, or other remunerations, as my Agent shall deem
9- 2 proper. ______
9- 3 12. Tax, Social Security, and Unemployment: To prepare,
9- 4 to make elections, to execute and to file all tax,
9- 5 social security, unemployment insurance, and
9- 6 informational returns required by the laws of the United
9- 7 States, or of any state or subdivision thereof, or of
9- 8 any foreign government; to prepare, to execute, and to
9- 9 file all other papers and instruments which the Agent
9-10 shall think to be desirable or necessary for
9-11 safeguarding of me against excess or illegal taxation or
9-12 against penalties imposed for claimed violation of any
9-13 law or other governmental regulation; and to pay, to
9-14 compromise, or to contest or to apply for refunds in
9-15 connection with any taxes or assessments for which I am
9-16 or may be liable. ______
9-17 13. Broad Powers: Without, in any way, limiting the
9-18 foregoing, generally to do, execute, and perform any
9-19 other act, deed, matter, or thing whatsoever, that
9-20 should be done, executed, or performed, including, but
9-21 not limited to, powers conferred by Code Section
9-22 53-12-232 of the Official Code of Georgia Annotated, or
9-23 that in the opinion of my Agent, should be done,
9-24 executed, or performed, for my benefit or the benefit of
9-25 my property, real or personal, and in my name of every
9-26 nature and kind whatsoever, as fully and effectually as
9-27 I could do if personally present. ______
9-28 14. Effective Date: This document will become effective
9-29 upon the date of the Principal's signature unless the
9-30 Principal indicates that it should become effective at a
9-31 later date by completing the following, which is
9-32 optional.
9-33 The powers conveyed in this document shall not become
9-34 effective until the following time or upon the
9-35 occurrence of the following event or contingency:
9-36
9-37
9-38 Note: The Principal may choose to designate one or more
9-39 persons to determine conclusively that the
9-40 above-specified event or contingency has occurred. Such
9-41 person or persons must make a written declaration under
9-42 penalty of false swearing that such event or contingency
-9-
10- 1 has occurred in order to make this document effective.
10- 2 Completion of this provision is optional.
10- 3 The following person or persons are designated to
10- 4 determine conclusively that the above-specified event or
10- 5 contingency has occurred:
10- 6
10- 7
10- 8 It is my desire and intention that this power of attorney
10- 9 shall not be affected by my subsequent disability,
10-10 incapacity, or mental incompetence. Any However, I
10-11 understand that it shall be revoked and the Agent's power
10-12 canceled in the event a guardian is appointed for my
10-13 property. As long as no such guardian is appointed, any
10-14 and all acts done by the Agent pursuant to the powers
10-15 conveyed herein during any period of my disability or,
10-16 incapacity, or mental incompetence shall have the same
10-17 force and effect as if I were competent and not disabled,
10-18 incapacitated, or mentally incompetent.
10-19 I may, at any time, revoke this power of attorney, but it
10-20 and it shall be canceled by my death. Otherwise, unless a
10-21 guardian is appointed for my property, this power of
10-22 attorney shall be deemed to be in full force and effect as
10-23 to all persons, institutions, and organizations which
10-24 shall act in reliance thereon prior to the receipt of
10-25 written revocation thereof signed by me and prior to
10-26 receipt of actual notice of my death.
10-27 I do hereby ratify and confirm all acts whatsoever which
10-28 my Agent shall do, or cause to be done, in or about the
10-29 premises, by virtue of this power of attorney.
10-30 All parties dealing in good faith with my Agent may fully
10-31 rely upon the power of and authority of my Agent to act
10-32 for me on my behalf and in my name, and may accept and
10-33 rely on agreements and other instruments entered into or
10-34 executed by the agent pursuant to this power of attorney.
10-35 This instrument shall not be effective as a grant of
10-36 powers to my Agent until my Agent has executed the
10-37 Acceptance of Appointment appearing at the end of this
-10-
11- 1 instrument. This instrument shall remain effective until
11- 2 revocation by me or my death, whichever occurs first.
11- 3 Compensation of Agent. (Directions: Initial the line
11- 4 following your choice.)
11- 5 1. My Agent shall receive no compensation for services
11- 6 rendered. ______
11- 7 2. My Agent shall receive reasonable compensation for
11- 8 services rendered. ______
11- 9 3. My Agent shall receive $__________ for services
11-10 rendered. ______
11-11 IN WITNESS WHEREOF, I have hereunto set my hand and seal
11-12 on this _____ day of ______________, 19__.
11-13 Note: A notarized signature is not required unless you
11-14 have initialed paragraph 3 or 4 regarding property
11-15 transactions.
11-16 I, _______________________, a Notary Public, do hereby
11-17 certify that _______________________ personally appeared
11-18 before me this date and acknowledged the due execution of
11-19 the foregoing Power of Attorney.
11-20 State of Georgia
11-21 County of ________
11-22 ACCEPTANCE OF APPOINTMENT
11-23 I, _______________________ (print name), have read the
11-24 foregoing Power of Attorney and am the person identified
11-25 therein as Agent for _______________________ (name of
11-26 grantor of power of attorney), the Principal named
11-27 therein. I hereby acknowledge the following:
-11-
12- 1 I owe a duty of loyalty and good faith to the Principal,
12- 2 and must use the powers granted to me only for the
12- 3 benefit of the Principal.
12- 4 I must keep the Principal's funds and other assets
12- 5 separate and apart from my funds and other assets and
12- 6 titled in the name of the Principal. I must not
12- 7 transfer title to any of the Principal's funds or other
12- 8 assets into my name alone. My name must not be added to
12- 9 the title of any funds or other assets of the Principal,
12-10 unless I am specifically designated as Agent for the
12-11 Principal in the title.
12-12 I must protect, and conserve, and exercise prudence and
12-13 caution in my dealings with, the Principal's funds and
12-14 other assets.
12-15 I must keep a full and accurate record of my acts,
12-16 receipts, and disbursements on behalf of the Principal,
12-17 and be ready to account to the Principal for such acts,
12-18 receipts, and disbursements at all times. I must
12-19 provide an annual accounting to the Principal of my
12-20 acts, receipts, and disbursements, and must furnish an
12-21 accounting of such acts, receipts, and disbursements to
12-22 the personal representative of the Principal's estate
12-23 within 90 days after the date of death of the Principal.
12-24 I have read the Compensation of Agent paragraph in the
12-25 Power of Attorney and agree to abide by it.
12-26 I acknowledge my authority to act on behalf of the
12-27 Principal ceases at the death of the Principal.
12-28 I hereby accept the foregoing appointment as Agent for the
12-29 Principal with full knowledge of the responsibilities
12-30 imposed on me, and I will faithfully carry out my duties
12-31 to the best of my ability.
12-32 Dated:______________, 19__.
12-33 Note: A notarized signature is not required unless the
12-34 Principal initialed paragraph 3 or paragraph 4 regarding
12-35 property transactions.
12-36 I, ________________________, a Notary Public, do hereby
12-37 certify that _______________________ personally appeared
-12-
13- 1 before me this date and acknowledge the due execution of
13- 2 the foregoing Acceptance of Appointment.
13- 3 SECTION 5.
13- 4 Title 31 of the Official Code of Georgia Annotated, relating
13- 5 to health, is amended by inserting a new chapter to be
13- 6 designated Chapter 36A to read as follows:
13- 7 31-36A-1.
13- 8 This chapter shall be known and may be cited as the
13- 9 'Temporary Health Care Placement Decision Maker for an
13-10 Adult Act.'
13-11 31-36A-2.
13-12 (a) The General Assembly recognizes that there may be
13-13 occasions when an adult has not made advance arrangements
13-14 for a situation when he or she is unable to consent to his
13-15 or her own admission to or discharge from one health care
13-16 facility or placement or transfer to another health care
13-17 facility or placement. Under these circumstances, the
13-18 General Assembly further recognizes that it may be
13-19 necessary and in the adult's best interest to be admitted
13-20 to or discharged from one health care facility or
13-21 placement or transferred to an alternative facility or
13-22 placement.
13-23 (b) In recognition of the findings in subsection (a) of
13-24 this Code section, the General Assembly declares that the
13-25 laws of the State of Georgia shall provide for the most
13-26 appropriate placement available for these individuals and
13-27 shall declare an order of priority for those persons who
13-28 may make the decision to transfer, admit, or discharge
13-29 such adults at the appointed times and a procedure for
13-30 obtaining authorization from the court in the absence of a
13-31 person authorized to consent.
13-32 31-36A-3.
13-33 As used in this chapter, the term:
13-34 (1) 'Absence of a person authorized to consent' means
13-35 that:
-13-
14- 1 (A) After diligent efforts for a reasonable period of
14- 2 time, no person authorized to consent under the
14- 3 provisions of Code Section 31-36A-6 has been located;
14- 4 or
14- 5 (B) All such authorized persons located have
14- 6 affirmatively waived their authority to consent or
14- 7 dissent to admission to or discharge from a health
14- 8 care facility or placement or transfer to an
14- 9 alternative health care facility or placement,
14-10 provided that dissent by an authorized person to a
14-11 proposed admission, discharge, or transfer shall not
14-12 be deemed waiver of authority.
14-13 (2) 'Unable to consent' means that an adult is unable
14-14 to:
14-15 (A) Make rational and competent decisions regarding
14-16 his or her placement options for health or personal
14-17 care; or
14-18 (B) Communicate such decisions by any means.
14-19 31-36A-4.
14-20 This chapter shall not apply to involuntary examination
14-21 and hospitalization for treatment of mental illness, which
14-22 shall continue to be governed by Title 37.
14-23 31-36A-5.
14-24 An attending physician, treating physician, or other
14-25 physician licensed according to the laws of the State of
14-26 Georgia, after having personally examined an adult, may
14-27 certify in the adult's medical records the following:
14-28 (1) The adult is unable to consent for himself or
14-29 herself; and
14-30 (2) It is the physician's belief that it is in the
14-31 adult's best interest to be discharged from a hospital,
14-32 institution, medical center, or other health care
14-33 institution providing health or personal care for
14-34 treatment of any type of physical or mental condition
14-35 and to be transferred to or admitted to an alternative
14-36 facility or placement, including, but not limited to,
14-37 nursing facilities, personal care homes, rehabilitation
14-38 facilities, and home and community based programs.
-14-
15- 1 31-36A-6.
15- 2 (a) Upon a physician's certification pursuant to Code
15- 3 Section 31-36A-5, and in addition to such other persons as
15- 4 may be otherwise authorized and empowered, any one of the
15- 5 following persons is authorized and empowered to consent,
15- 6 in the priority order listed below, either orally or
15- 7 otherwise, to such transfer, admission, or discharge:
15- 8 (1) Any adult, for himself or herself;
15- 9 (2) Any person authorized to give such consent for the
15-10 adult under a health care agency complying with Chapter
15-11 36 of this title, the 'Durable Power of Attorney for
15-12 Health Care Act';
15-13 (3) Any guardian of the person for his or her ward;
15-14 (4) Any spouse for his or her spouse;
15-15 (5) Any adult child for such person's parent;
15-16 (6) Any parent for such person's adult child;
15-17 (7) Any adult for such person's adult brother or sister;
15-18 (8) Any grandparent for such person's adult grandchild;
15-19 (9) Any adult grandchild for such person's grandparent;
15-20 (10) Any adult uncle or aunt for such person's adult
15-21 nephew or niece; or
15-22 (11) Any adult nephew or niece for such person's adult
15-23 uncle or aunt.
15-24 (b) Any person authorized and empowered to consent under
15-25 subsection (a) of this Code section shall, after being
15-26 informed of the provisions of this Code section, act in
15-27 good faith to consent to a transfer, admission, or
15-28 discharge which the patient would have wanted had the
15-29 patient been able to consent in the circumstances under
15-30 which such transfer, admission, or discharge is considered
15-31 or, if the patient's preferences are unknown, which such
15-32 person believes the patient would have wanted had the
15-33 patient been able to consent in the circumstances under
15-34 which such transfer, admission, or discharge is
15-35 considered. The current health care facility's discharge
15-36 planner, social worker, or other designated personnel
15-37 shall assist the person authorized to consent under
15-38 subsection (a) of this Code section with identifying the
15-39 most appropriate, least restrictive level of care
-15-
16- 1 available, including home and community based services and
16- 2 available placements, if any, in reasonable proximity to
16- 3 the patient's residence.
16- 4 (c) The authorization to consent to such transfer,
16- 5 admission, or discharge shall expire upon the earliest of
16- 6 the following:
16- 7 (1) The completion of the transfer, admission, or
16- 8 discharge and such responsibilities associated with such
16- 9 transfer, admission, or discharge, including, but not
16-10 limited to, assisting with applications for financial
16-11 coverage and insurance benefits for health or personal
16-12 care;
16-13 (2) Upon a physician's certification that the adult is
16-14 able to consent to decisions regarding his or her
16-15 placements for health or personal care; or
16-16 (3) Upon discovery that another person authorized under
16-17 subsection (a) of this Code section of a higher priority
16-18 is available who has not affirmatively waived his or her
16-19 authority to consent or dissent to admission to or
16-20 discharge from a health care facility or placement or
16-21 transfer to an alternative health care facility or
16-22 placement, provided that dissent by such authorized
16-23 person to a proposed admission, discharge, or transfer
16-24 shall not be deemed waiver of authority.
16-25 (d) The authorization to give consent for transfer,
16-26 admission, or discharge is limited solely to said
16-27 transfer, admission, or discharge decision and
16-28 responsibilities associated with such decision, including
16-29 providing assistance with financial assistance
16-30 applications. It does not include the power or authority
16-31 to perform any other acts on behalf of the adult not
16-32 expressly authorized in this Code section.
16-33 (e) This Code section shall not repeal, abrogate, or
16-34 impair the operation of any other laws, either federal or
16-35 state, governing the transfer, admission, or discharge of
16-36 a person to or from a health care facility or placement.
16-37 Further, the adult retains all rights provided under laws,
16-38 both federal and state, as a result of an involuntary
16-39 transfer, admission, or discharge.
16-40 (f) Each certifying physician, discharge planner, social
16-41 worker, or other hospital personnel or authorized person
16-42 who acts in good faith pursuant to the authority of this
-16-
17- 1 Code section shall not be subject to any civil or criminal
17- 2 liability or discipline for unprofessional conduct.
17- 3 31-36A-7.
17- 4 (a) In the absence of a person authorized to consent under
17- 5 the provisions of Code Section 31-36A-6, any interested
17- 6 person or persons, including, but not limited to, any
17- 7 authority, corporation, partnership, or other entity
17- 8 operating the health care facility where the adult who is
17- 9 unable to consent is then present, with or without the
17-10 assistance of legal counsel, may petition the probate
17-11 court for a health care placement transfer, admission, or
17-12 discharge order. The petition must be verified and filed
17-13 in the county where the adult requiring an alternative
17-14 placement or transfer, admission, or discharge resides or
17-15 is found, provided that the probate court of the county
17-16 where the adult is found shall not have jurisdiction to
17-17 grant the order if it appears that the adult was removed
17-18 to that county solely for purposes of filing such a
17-19 petition. The petition shall set forth:
17-20 (1) The name, age, address, and county of the residence
17-21 of the adult, if known;
17-22 (2) The name, address, and county of residence of the
17-23 petitioner;
17-24 (3) The relationship of the petitioner to the adult;
17-25 (4) The current location of the adult;
17-26 (5) A physician's certification pursuant to Code Section
17-27 31-36A-5;
17-28 (6) The absence of any person to consent to such
17-29 transfer, admission, or discharge as authorized by the
17-30 provisions of Code Section 31-36A-6;
17-31 (7) Name and address of the recommended alternative
17-32 health care facility or placement; and
17-33 (8) A statement of the reasons for such transfer,
17-34 admission, or discharge as required by subsections (b)
17-35 and (c) of this Code section.
17-36 (b) The petition shall be supported by the affidavit of an
17-37 attending physician, treating physician, or other
17-38 physician licensed according to the laws of the State of
17-39 Georgia, attesting the following:
-17-
18- 1 (1) The adult is unable to consent for himself or
18- 2 herself;
18- 3 (2) It is the physician's belief that it is in the
18- 4 adult's best interest to be admitted to or discharged
18- 5 from a hospital, institution, medical center, or other
18- 6 health care institution providing health or personal
18- 7 care for treatment of any type of physical or mental
18- 8 condition or to be transferred to an alternative
18- 9 facility or placement, including, but not limited to,
18-10 nursing facilities, personal care homes, rehabilitation
18-11 facilities, and home and community based programs; and
18-12 (3) The identified type of health care facility or
18-13 placement will provide the adult with the recommended
18-14 services to meet the needs of the adult and is the most
18-15 appropriate, least restrictive level of care available.
18-16 (c) The petition shall also be supported by the affidavit
18-17 of the discharging health care facility's discharge
18-18 planner, social worker, or other designated personnel
18-19 attesting to and explaining the following:
18-20 (1) There is an absence of a person to consent to such
18-21 transfer, admission, or discharge as authorized in Code
18-22 Section 31-36A-6;
18-23 (2) The recommended alternative facility or placement is
18-24 the most appropriate facility or placement available
18-25 that provides the least restrictive and most appropriate
18-26 level of care and reasons therefor; and
18-27 (3) Alternative facilities or placements were
18-28 considered, including home and community based
18-29 placements and available placements, if any, that were
18-30 in reasonable proximity to the adult's residence.
18-31 (d) The court shall review the petition and accompanying
18-32 affidavits and other information to determine if all the
18-33 necessary information is provided to the court as required
18-34 in subsections (a), (b), and (c) of this Code section. The
18-35 court shall enter an instanter order if the following
18-36 information is provided:
18-37 (1) The adult is unable to consent for himself or
18-38 herself;
18-39 (2) There is an absence of any person to consent to such
18-40 transfer, admission, or discharge as authorized in Code
18-41 Section 31-36A-6;
-18-
19- 1 (3) It is in the adult's best interest to be discharged
19- 2 from a hospital, institution, medical center, or other
19- 3 health care institution or placement providing health or
19- 4 personal care for treatment for any type of physical or
19- 5 mental condition and to be admitted or transferred to an
19- 6 alternative facility or placement;
19- 7 (4) The recommended alternative facility or placement is
19- 8 the most appropriate facility or placement available
19- 9 that provides the least restrictive and most appropriate
19-10 level of care; and
19-11 (5) Alternative facilities or placements were
19-12 considered, including home and community based
19-13 placements and available placements, if any, in
19-14 reasonable proximity to the adult's residence.
19-15 The order shall authorize the petitioner or the
19-16 petitioner's designee to do all things necessary to
19-17 accomplish the discharge from a hospital, institution,
19-18 medical center, or other health care institution and the
19-19 transfer to or admission to the recommended facility or
19-20 placement.
19-21 (e) At the same time as issuing the order, the court shall
19-22 provide a copy of said order to the commissioner of human
19-23 resources.
19-24 (f) The order authorizing such transfer, admission, or
19-25 discharge shall expire upon the earliest of the following:
19-26 (1) The completion of the transfer, admission, or
19-27 discharge and such responsibilities associated with such
19-28 transfer, admission, or discharge, including, but not
19-29 limited to, assisting with the completion of
19-30 applications for financial coverage and insurance
19-31 benefits for the health or personal care;
19-32 (2) Upon a physician's certification that the adult is
19-33 able to understand and make decisions regarding his or
19-34 her placements for health or personal care and can
19-35 communicate such decisions by any means; or
19-36 (3) At a time specified by the court not to exceed 30
19-37 days from the date of the order.
19-38 (g) The order is limited to authorizing the transfer,
19-39 admission, or discharge and other responsibilities
19-40 associated with such decision, such as authorizing the
19-41 application for financial coverage and insurance
-19-
20- 1 benefits. It does not include the authority to perform
20- 2 any other acts on behalf of the adult not expressly
20- 3 authorized in this Code section.
20- 4 (h) This Code section shall not repeal, abrogate, or
20- 5 impair the operation of any other laws, either federal or
20- 6 state, governing the transfer, admission, or discharge of
20- 7 a person to or from a health care facility or placement.
20- 8 Further, such person retains all rights provided under
20- 9 laws, both federal and state, as a result of an
20-10 involuntary transfer, admission, or discharge.
20-11 (i) Each certifying physician, discharge planner, social
20-12 worker, or other hospital personnel or authorized person
20-13 who acts in good faith pursuant to the authority of this
20-14 Code section shall not be subject to any civil or criminal
20-15 liability or discipline for unprofessional conduct."
20-16 SECTION 6.
20-17 Said title is further amended by striking in its entirety
20-18 subsection (c) of Code Section 31-36-6, relating to
20-19 revocation or amendment of the agency, and inserting in its
20-20 place the following:
20-21 "(c) A health care agency which survives disability,
20-22 incapacity, or incompetency shall not be revoked solely by
20-23 the appointment of a guardian or receiver for the
20-24 principal. Absent an order of a court of competent of the
20-25 probate court or superior court having jurisdiction
20-26 directing a guardian of the person to exercise the powers
20-27 of the principal under an under a health care agency that
20-28 survives disability, incapacity, or incompetency, the
20-29 guardian of the person has no power, duty, or liability
20-30 with respect to any personal or health care matters
20-31 covered by the agency; provided, however, that no order
20-32 usurping the authority of an agent known to the proposed
20-33 guardian shall be entered unless there is notice to said
20-34 agent by first class mail to the agent's last known
20-35 address and it is shown by clear and convincing evidence
20-36 that the agent is acting in a manner inconsistent with the
20-37 power of attorney."
20-38 SECTION 7.
20-39 Said title is further amended in Code Section 31-36-10,
20-40 relating to the form of a power of attorney for health care
20-41 and powers authorized, by striking subsection (a) in its
20-42 entirety, and inserting in its place the following:
-20-
21- 1 "(a) The statutory health care power of attorney form
21- 2 contained in this subsection may be used to grant an agent
21- 3 powers with respect to the principal's own health care;
21- 4 but the statutory health care power is not intended to be
21- 5 exclusive or to cover delegation of a parent's power to
21- 6 control the health care of a minor child, and no provision
21- 7 of this chapter shall be construed to bar use by the
21- 8 principal of any other or different form of power of
21- 9 attorney for health care that complies with Code Section
21-10 31-36-5. If a different form of power of attorney for
21-11 health care is used, it may contain any or all of the
21-12 provisions set forth or referred to in the following form.
21-13 When a power of attorney in substantially the following
21-14 form is used, including the and notice paragraph in
21-15 capital letters at the beginning, substantially similar to
21-16 that contained in the form below has been provided to the
21-17 patient, it shall have the same meaning and effect as
21-18 prescribed in this chapter. Substantially similar forms
21-19 may include forms from other states. The statutory health
21-20 care power may be included in or combined with any other
21-21 form of power of attorney governing property or other
21-22 matters:
21-23 'GEORGIA STATUTORY SHORT FORM
21-24 DURABLE POWER OF ATTORNEY FOR HEALTH CARE
21-25 NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO
21-26 GIVE THE PERSON YOU DESIGNATE (YOUR AGENT) BROAD POWERS
21-27 TO MAKE HEALTH CARE DECISIONS FOR YOU, INCLUDING POWER
21-28 TO REQUIRE, CONSENT TO, OR WITHDRAW ANY TYPE OF PERSONAL
21-29 CARE OR MEDICAL TREATMENT FOR ANY PHYSICAL OR MENTAL
21-30 CONDITION AND TO ADMIT YOU TO OR DISCHARGE YOU FROM ANY
21-31 HOSPITAL, HOME, OR OTHER INSTITUTION; BUT NOT INCLUDING
21-32 PSYCHOSURGERY, STERILIZATION, OR INVOLUNTARY
21-33 HOSPITALIZATION OR TREATMENT COVERED BY TITLE 37 OF THE
21-34 OFFICIAL CODE OF GEORGIA ANNOTATED. THIS FORM DOES NOT
21-35 IMPOSE A DUTY ON YOUR AGENT TO EXERCISE GRANTED POWERS;
21-36 BUT, WHEN A POWER IS EXERCISED, YOUR AGENT WILL HAVE TO
21-37 USE DUE CARE TO ACT FOR YOUR BENEFIT AND IN ACCORDANCE
21-38 WITH THIS FORM. A COURT CAN TAKE AWAY THE POWERS OF
21-39 YOUR AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY.
21-40 YOU MAY NAME COAGENTS AND SUCCESSOR AGENTS UNDER THIS
21-41 FORM, BUT YOU MAY NOT NAME A HEALTH CARE PROVIDER WHO
21-42 MAY BE DIRECTLY OR INDIRECTLY INVOLVED IN RENDERING
21-43 HEALTH CARE TO YOU UNDER THIS POWER. UNLESS YOU
21-44 EXPRESSLY LIMIT THE DURATION OF THIS POWER IN THE MANNER
21-45 PROVIDED BELOW OR UNTIL YOU REVOKE THIS POWER OR A COURT
-21-
22- 1 ACTING ON YOUR BEHALF TERMINATES IT, YOUR AGENT MAY
22- 2 EXERCISE THE POWERS GIVEN IN THIS POWER THROUGHOUT YOUR
22- 3 LIFETIME, EVEN AFTER YOU BECOME DISABLED, INCAPACITATED,
22- 4 OR INCOMPETENT. THE POWERS YOU GIVE YOUR AGENT, YOUR
22- 5 RIGHT TO REVOKE THOSE POWERS, AND THE PENALTIES FOR
22- 6 VIOLATING THE LAW ARE EXPLAINED MORE FULLY IN CODE
22- 7 SECTIONS 31-36-6, 31-36-9, AND 31-36-10 OF THE GEORGIA
22- 8 "DURABLE POWER OF ATTORNEY FOR HEALTH CARE ACT" OF WHICH
22- 9 THIS FORM IS A PART (SEE THE BACK OF THIS FORM). THAT
22-10 ACT EXPRESSLY PERMITS THE USE OF ANY DIFFERENT FORM OF
22-11 POWER OF ATTORNEY YOU MAY DESIRE. IF THERE IS ANYTHING
22-12 ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU SHOULD
22-13 ASK A LAWYER TO EXPLAIN IT TO YOU.
22-14 DURABLE POWER OF ATTORNEY made this _______ day of
22-15 ______________, 19__.
22-16 1. I,
22-17
22-18 (insert name and address of principal)
22-19 hereby appoint
22-20 as my attorney in fact (my agent) to act for me and in
22-21 my name in any way I could act in person to make any and
22-22 all decisions for me concerning my personal care,
22-23 medical treatment, hospitalization, and health care and
22-24 to require, withhold, or withdraw any type of medical
22-25 treatment or procedure, even though my death may ensue.
22-26 My agent shall have the same access to my medical
22-27 records that I have, including the right to disclose the
22-28 contents to others. My agent shall also have full power
22-29 to make a disposition of any part or all of my body for
22-30 medical purposes, authorize an autopsy of my body, and
22-31 direct the disposition of my remains.
22-32 THE ABOVE GRANT OF POWER IS INTENDED TO BE AS BROAD AS
22-33 POSSIBLE SO THAT YOUR AGENT WILL HAVE AUTHORITY TO MAKE
22-34 ANY DECISION YOU COULD MAKE TO OBTAIN OR TERMINATE ANY
22-35 TYPE OF HEALTH CARE, INCLUDING WITHDRAWAL OF NOURISHMENT
22-36 AND FLUIDS AND OTHER LIFE-SUSTAINING OR DEATH-DELAYING
22-37 MEASURES, IF YOUR AGENT BELIEVES SUCH ACTION WOULD BE
22-38 CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU WISH TO
22-39 LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE
22-40 SPECIAL RULES TO LIMIT THE POWER TO MAKE AN ANATOMICAL
22-41 GIFT, AUTHORIZE AUTOPSY, OR DISPOSE OF REMAINS, YOU MAY
22-42 DO SO IN THE FOLLOWING PARAGRAPHS.
-22-
23- 1 2. The powers granted above shall not include the
23- 2 following powers or shall be subject to the following
23- 3 rules or limitations (here you may include any specific
23- 4 limitations you deem appropriate, such as your own
23- 5 definition of when life-sustaining or death-delaying
23- 6 measures should be withheld; a direction to continue
23- 7 nourishment and fluids or other life-sustaining or
23- 8 death-delaying treatment in all events; or instructions
23- 9 to refuse any specific types of treatment that are
23-10 inconsistent with your religious beliefs or unacceptable
23-11 to you for any other reason, such as blood transfusion,
23-12 electroconvulsive therapy, or amputation):
23-13
23-14
23-15
23-16 THE SUBJECT OF LIFE-SUSTAINING OR DEATH-DELAYING
23-17 TREATMENT IS OF PARTICULAR IMPORTANCE. FOR YOUR
23-18 CONVENIENCE IN DEALING WITH THAT SUBJECT, SOME GENERAL
23-19 STATEMENTS CONCERNING THE WITHHOLDING OR REMOVAL OF
23-20 LIFE-SUSTAINING OR DEATH-DELAYING TREATMENT ARE SET
23-21 FORTH BELOW. IF YOU AGREE WITH ONE OF THESE STATEMENTS,
23-22 YOU MAY INITIAL THAT STATEMENT, BUT DO NOT INITIAL MORE
23-23 THAN ONE:
23-24 I do not want my life to be prolonged nor do I want
23-25 life-sustaining or death-delaying treatment to be
23-26 provided or continued if my agent believes the burdens
23-27 of the treatment outweigh the expected benefits. I
23-28 want my agent to consider the relief of suffering, the
23-29 expense involved, and the quality as well as the
23-30 possible extension of my life in making decisions
23-31 concerning life-sustaining or death-delaying
23-32 treatment.
23-33 I want my life to be prolonged and I want
23-34 life-sustaining or death-delaying treatment to be
23-35 provided or continued unless I am in a coma, including
23-36 a persistent vegetative state, which my attending
23-37 physician believes to be irreversible, in accordance
23-38 with reasonable medical standards at the time of
23-39 reference. If and when I have suffered such an
23-40 irreversible coma, I want life-sustaining or
23-41 death-delaying treatment to be withheld or
23-42 discontinued.
-23-
24- 1 I want my life to be prolonged to the greatest extent
24- 2 possible without regard to my condition, the chances I
24- 3 have for recovery, or the cost of the procedures.
24- 4 THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY YOU
24- 5 AT ANY TIME AND IN ANY MANNER WHILE YOU ARE ABLE TO DO
24- 6 SO. IN THE ABSENCE OF AN AMENDMENT OR REVOCATION, THE
24- 7 AUTHORITY GRANTED IN THIS POWER OF ATTORNEY WILL BECOME
24- 8 EFFECTIVE AT THE TIME THIS POWER IS SIGNED AND WILL
24- 9 CONTINUE UNTIL YOUR DEATH AND WILL CONTINUE BEYOND YOUR
24-10 DEATH IF ANATOMICAL GIFT, AUTOPSY, OR DISPOSITION OF
24-11 REMAINS IS AUTHORIZED, UNLESS A LIMITATION ON THE
24-12 BEGINNING DATE OR DURATION IS MADE BY INITIALING AND
24-13 COMPLETING EITHER OR BOTH OF THE FOLLOWING:
24-14 3. ( ) This power of attorney shall become effective on
24-15 ________________________ (insert a future date or event
24-16 during your lifetime, such as court determination of
24-17 your disability, incapacity, or incompetency, when you
24-18 want this power to first take effect).
24-19 4. ( ) This power of attorney shall terminate on
24-20 _______________________ (insert a future date or event,
24-21 such as court determination of your disability,
24-22 incapacity, or incompetency, when you want this power to
24-23 terminate prior to your death).
24-24 IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAMES
24-25 AND ADDRESSES OF SUCH SUCCESSORS IN THE FOLLOWING
24-26 PARAGRAPH:
24-27 5. If any agent named by me shall die, become legally
24-28 disabled, incapacitated, or incompetent, or resign,
24-29 refuse to act, or be unavailable, I name the following
24-30 (each to act successively in the order named) as
24-31 successors to such agent:
24-32
24-33
24-34 IF YOU WISH TO NAME A GUARDIAN OF YOUR PERSON IN THE
24-35 EVENT A COURT DECIDES THAT ONE SHOULD BE APPOINTED, YOU
24-36 MAY, BUT ARE NOT REQUIRED TO, DO SO BY INSERTING THE
24-37 NAME OF SUCH GUARDIAN IN THE FOLLOWING PARAGRAPH. THE
24-38 COURT WILL APPOINT THE PERSON NOMINATED BY YOU IF THE
24-39 COURT FINDS THAT SUCH APPOINTMENT WILL SERVE YOUR BEST
24-40 INTERESTS AND WELFARE. YOU MAY, BUT ARE NOT REQUIRED
-24-
25- 1 TO, NOMINATE AS YOUR GUARDIAN THE SAME PERSON NAMED IN
25- 2 THIS FORM AS YOUR AGENT.
25- 3 6. If a guardian of my person is to be appointed, I
25- 4 nominate the following to serve as such guardian:
25- 5
25- 6 (insert name and address of nominated guardian of the
25- 7 person)
25- 8 7. I am fully informed as to all the contents of this
25- 9 form and understand the full import of this grant of
25-10 powers to my agent.
25-11 The principal has had an opportunity to read the above
25-12 form and has signed the above form in our presence. We,
25-13 the undersigned, each being over 18 years of age,
25-14 witness the principal's signature at the request and in
25-15 the presence of the principal, and in the presence of
25-16 each other, on the day and year above set out.
25-17 Witnesses: Addresses:
25-18 ______________________ _________________________
25-19 ______________________ _________________________
25-20 Additional witness required when health care agency is
25-21 signed in a hospital or skilled nursing facility.
25-22 I hereby witness this health care agency and attest that
25-23 I believe the principal to be of sound mind and to have
25-24 made this health care agency willingly and voluntarily.
25-25 YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND
25-26 SUCCESSOR AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW.
25-27 IF YOU INCLUDE SPECIMEN SIGNATURES IN THIS POWER OF
25-28 ATTORNEY, YOU MUST COMPLETE THE CERTIFICATION OPPOSITE
25-29 THE SIGNATURES OF THE AGENTS.
-25-
26- 1 Specimen signatures of and successor(s) is
26- 2 agent and successor(s) correct.
26- 3 ________________________ ________________________
26- 4 (Agent) (Principal)
26- 5 ________________________ ________________________
26- 6 (Successor agent) (Principal)
26- 7 ________________________ ________________________
26- 8 (Successor agent) (Principal)'"
26- 9 SECTION 8.
26-10 All laws and parts of laws in conflict with this Act are
26-11 repealed.
-26-
Clerk of the House
Robert E. Rivers, Jr., Clerk
Last Updated on 05/05/99
