Home > Legal > Legal > Power of Attorney Template > Maine Power of Attorney Form > Maine Health Care Power of Attorney Form 2

Maine Health Care Power of Attorney Form 2

At Speedy Template, You can download Maine Health Care Power of Attorney Form 2 . There are a few ways to find the forms or templates you need. You can choose forms in your state, use search feature to find the related forms. At the end of each page, there is "Download" button for the forms you are looking form if the forms don't display properly on the page, the Word or Excel or PDF files should give you a better reivew of the page.

Maine Health Care Power of Attorney Form 2
Maine Health Care Power of Attorney Form 2
last revised 9/7/2004
1
Advance Health-Care Directive Form
18-A M.R.S.A. §§ 5-801 - 5-817
(See Instructions)
PART 1—Selection of My Agent
(Durable Power of Attorney for Health Care)
(Sections 1 through 4)
(1) DESIGNATION OF AGENT: I designate the following individual as my Agent to make health-care
decisions for me:
(name of individual you choose as Agent)
(address)
(city) (state) (zip code)
(home phone)
(work phone)
OPTIONAL: If I revoke my Agent's authority or if my Agent is not willing, able or reasonably
available to make a health-care decision for me, I designate as my first alternate Agent:
(name of individual you choose as first alternate Agent)
(address)
(city) (state) (zip code)
(home phone)
(work phone)
Maine Health Care Power of Attorney Form 2
Previous

1/7

Next