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201305031
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Last modified
8/19/2014 2:23:25 PM
Creation date
6/25/2013 8:21:15 AM
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DEEDS
Inst Number
201305031
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F. Court Enforcement. My Agent shall have the power to seek appropriate court <br />orders mandating acts which my Agent deems appropriate if a third party refuses to comply with <br />decisions made by my Agent which are authorized by this document, or enjoining acts by third <br />parties which my Agent has not authorized. My Agent may bring legal action against any third <br />party who fails to comply with actions I have authorized my Agent to take and demand damages <br />on my behalf for such noncompliance. <br />G Reliance On Photocopy. Third parties shall be entitled to rely on a photocopy <br />of the signed Original hereof. <br />H. Applicable Law. The laws of the State of Nebraska shall govern this Power of <br />Attorney. This Power of Attorney is intended to be valid m any jurisdiction m which it is <br />presented. <br />I. HIPAA Release Authority. I intend for my agent to be treated as I <br />would be with respect to my rights regarding the use and disclosure of my individually <br />identifiable health information or other medical records. This release authority applies to any <br />information governed by the Health Insurance Portability and Accountability Act of 1996 (aka <br />HIPAA), 42 USC 1320d and 45 CFR 160 -164.I authorize: any physician, health -care <br />professional, dentist, health plan, hospital, clinic, laboratory, pharmacy or other covered <br />health -care provider, any insurance company and the Medical Information Bureau Inc. or other <br />health -care clearinghouse that has provided treatment or services to me, or that has paid for or is <br />seeking payment from me for such services, to give, disclose and release to my agent, without <br />restriction, all of my individually identifiable health information and medical records regarding <br />any past, present or future medical or mental health condition, including all information relating <br />to the diagnosis and treatment of HIV /AIDS, sexually transmitted diseases, mental illness, and <br />drug or alcohol abuse. <br />The authority given my agent shall supersede any prior agreement that I may have made <br />with my health -care providers to restrict access to or disclosure of my individually identifiable <br />health information. The authority given my agent has no expiration date and shall expire only in <br />the event that I revoke the authority m writing and deliver it to my health -care provider. <br />DPOAF of Evelyn P. Magnuson Page 14 of 16 Initials <br />201305031 <br />Date: f1 3 .. d5' <br />
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