Outline
When it comes to making important healthcare decisions, having a trusted individual by your side can provide peace of mind. In South Carolina, a Medical Power of Attorney form is a vital tool that allows you to designate someone to make medical decisions on your behalf if you become unable to do so yourself. This legal document empowers your chosen agent to communicate with healthcare providers, access your medical records, and make choices regarding treatments and procedures based on your preferences. It’s essential to understand that this form not only addresses immediate medical needs but also encompasses long-term care decisions. By outlining your wishes clearly, you ensure that your healthcare aligns with your values and desires, even when you cannot voice them. Furthermore, the form must be signed and dated in the presence of a notary public or witnesses to be valid, ensuring that your intentions are legally recognized. Whether you are planning for the future or addressing current health concerns, creating a Medical Power of Attorney in South Carolina is a proactive step in safeguarding your health and autonomy.
Form Sample
South Carolina Medical Power of Attorney
This document is designed in accordance with the South Carolina Adult Health Care Consent Act, allowing individuals to appoint another person to make health care decisions on their behalf should they become unable to do so themselves.
Principal Information
Name: _______________________________
Date of Birth: _______________________
Address: _____________________________
______________________________________
Phone Number: ________________________
Email: _______________________________
Agent Information
Name: _______________________________
Relationship to Principal: ______________
Address: _____________________________
______________________________________
Phone Number: ________________________
Email: _______________________________
Alternate Agent Information(To act if the primary agent is unable, unwilling, or unavailable)
Name: _______________________________
Relationship to Principal: ______________
Address: _____________________________
______________________________________
Phone Number: ________________________
Email: _______________________________
Authority Granted to Agent
This Medical Power of Attorney authorizes the Agent named above to make any and all health care decisions for the Principal that the Principal could make if capable. This authority covers all medical and health care decisions except those the Principal specifies here:
______________________________________
______________________________________
Special Instructions/Limitations (Optional)
______________________________________
______________________________________
Duration of the Medical Power of Attorney
This Medical Power of Attorney is effective upon the signature of the Principal and continues until the Principal revokes it or it is terminated by the Principal's death unless a specific expiration date is stated below:
Expiration Date (if applicable): _________
Signature
By signing below, I affirm that I understand the nature and purpose of this document and the authority it grants to my Agent. I am signing this document voluntarily and am of sound mind.
_________________________ _______________
Signature of Principal Date
_________________________ _______________
Signature of Agent Date
_________________________ _______________
Signature of Alternate Agent Date
Witnesses (As required by South Carolina law, this document must be signed in the presence of two witnesses who are not related to the Principal by blood or marriage and who are not beneficiaries of the Principal's estate.)
Witness 1: _________________________ _______________
Signature Date
Witness 2: _________________________ _______________
Signature Date
Notarization (If required or desired)
This document was notarized by me on the date below:
Notary Public: ___________________ _______________
Signature Date
My commission expires: ______________
Form Attributes
| Fact Name | Description |
|---|---|
| Definition | The South Carolina Medical Power of Attorney form allows individuals to designate someone to make healthcare decisions on their behalf if they become incapacitated. |
| Governing Law | This form is governed by South Carolina Code of Laws, Title 62, Chapter 5, which outlines the legal framework for health care powers of attorney. |
| Requirements | The form must be signed by the principal and witnessed by two individuals who are not related to the principal or named as agents in the document. |
| Durability | The South Carolina Medical Power of Attorney remains effective even if the principal becomes mentally incapacitated, ensuring continuous decision-making authority. |
| Revocation | The principal can revoke the Medical Power of Attorney at any time, provided they do so in writing and communicate the revocation to the designated agent. |
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