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j � .. _ <br /> . � ._ ..._-::------- <br /> �;W --,_....__• ___ --- — — <br /> • 9?'" l0'7°,�39 <br /> � � �►�r � � � <br /> i appo�nt Clara J. (8�lly) ltuo�rs� �+ho�� addr��• i� 1824 Nosth <br /> ssylor ]►v�., orsad I�7�and. x�bra�ka 60t03, aad «ho�� t�l�phoa� aw�b�r ir 308- �---- <br /> 394-955a� a� �ay atitorn�y in iao� !or h�alth ou�. i a�gaint I.ori 11. Bual�acl: <br /> who�� x&���� i� 116 s. Tild�n, Grand S�Iand, N�bra�ka 68801, aad whos� <br /> t�l�p�oa� ni�r i• 3tl8-�8�-4825, a� �04► �uoa��nor Atitorn�y in taat !or haalth <br /> ouw. t apPoint 1c�via s. Pura�il, rho�� ad�ilAN �.� iZ933 ltargo� anaha. _ <br /> lt�brs�ka 6s139, aad whoi� t�l�phon� nunb�r i.o �01-895-3412, a� �►y la�t <br /> �uaa���or attosa�y 3a laat !or h�alth cas'�, �honld Lozi 11. Suohola not b� ab1� <br /> to �s�r,r�. 7 authoris� s►y attora�y ia taat appoiatrd by thi� doaum�nt to aa]c� <br /> h�alth csar� d�ci.�ion� fo�c aw M�ipn i aat d�t�rmiaed to b� i.aaapabi� o! �aakinq n7t <br /> owa health car� da►oisions. I haw r�ui th� �srninq Mhich aoaoopsnie� t�►i� <br /> doouawnt sad und�tstaad th� con��qu�no�• ot �x�ou�ing a pow�r ot attorn�y for <br /> h�alth au�. <br /> Z ,dir�ot Chat my attara�y ia �ant aaa�ply Mith th� folloxiaq <br /> instruotion� os li�ai.tation�e Mty attozn�y in faot �hall hav� th� daty to <br /> aoaault vith th� th� appropriat� m�diosl p�r�ona�l, inaludinq my att�nding <br /> phy�ioiaa, +u�d th�reupoa as)c� h�alth car� d�aidon� in aaaordaaa�with A►y <br /> vi�h�s a� �x�r��s�d in thi� ��r of attorn�y for health car�� or aa oth�r�►i�� <br /> i IIwa� made knam to aty attorn�y ia laat, or i! my wiah�s ar� �ot r�asoaably <br /> knc�m and osnaot with x�asoaabl� diliq�nae ba naa�rtaia�d, i�a acsaordaua� ++ith <br /> siy b��t iat�r�sts, �rith du� x�qsrd for ny r�liqious and noral b�li�ta. <br /> Za �x�rcisiag aay d�ci�ion, mY dttoraey ia laot �hall hav� uo <br /> suthority to �rithhald or Withdraw aott��nt to rou�in� aar� a�o+a�ary to <br /> yiaiatain my aoealort or th� usual aad typioal yrovis toa ot nutacitioa and <br /> • hydratioa, ual��■ ap�ciliaally allaw�d has�af.C�r. <br /> Z d�.r�ct that �ay attorn�y ia faot aoaply orith tha folloxing <br /> iastsaations oa lit�-�u�taiaing tr�ata�nt: �ty attora�y ia laati �hall haas th� <br /> authority to coa��nt to th� aithholdinq or withdravinq ot a lit�-�u�taininq <br /> proaodur� i! Z am au!l�rinq tran a t�rninsl aondition or if i a�nin a <br /> p�rsist�nt wqatatiw stat�. <br /> I dir�ot that my attorn�y ia faat caoplp aith tb� tollwring <br /> ia�tiruation� oa utifiaially adnintst�r�d nutrition nad bydrations 14y <br />_ ��L•ora�y in laat ahn].1 haw tho auehoritp ta aonsont to tt.� vithholding or <br /> aithdrawinq o! art�.�iaially admini�terrd nutritioa or hydration if I am <br /> �u!lar�.aq tro� a t�rminal coadition or i am 3n s por�istaat v�gatatfw �tat�. <br /> Dat�d thi� J� day af X/ � , 1995. <br /> � _� ��„ ,�. <br /> �y��sc,�,t,. � <br /> Bigaataiz� oi por�on makiaq d�t�ruinatioa <br /> rr.dnk J. 1CUOOra, sr. <br /> - Pag� 1 oi 3 paq�s <br />