201508776 - Laserfiche WebLink

Browse

No Restrictions General Power for Real Estate. General Power for Securities. General Power for Records, Reports, and Statements. 201508776 3. By this Power of Attorney, Principal makes the following additional provision or provisions: 4. This Power of Attorney revokes and supersedes all prior executed instruments of like import and remains operative until revoked. 5. Privacy Waiver. Regardless of the time of commencement of the other powers granted my attorney -in -fact by this document, I authorize all physicians and psychiatrists who have treated me, and all other providers of health care, including hospitals, to release to my attorney -in -fact all information or photocopies of any records which my attorney -in -fact may request. Any medical information released will serve the purpose of allowing my attorney -in- fact to fulfill the obligations set forth in this document. All persons are authorized to treat any request for information by my attorney -in -fact as the request of my personal representative and to honor such requests as if they were my own. I hereby waive all privileges which may be applicable to such information and records and to any communication pertaining to me and made in the course of any confidential relationship recognized by law. My attorney -in -fact may also disclose such information to such persons as my attorney -in -fact shall deem appropriate. I understand that any information redisclosed by my attorney -in -fact is no longer protected by federal privacy regulations covering health care providers. Furthermore, I understand that this authorization for release of medical information may be revoked in writing at any time, except to the extent that the health care provider has taken action in reliance on the authorization. This authorization for release of medical information shall expire upon the earlier event of my naming of a new attorney -in -fact for health care, or two (2) years following my death. This authorization and request shall also be considered a consent to the release of such information under current laws, rules and regulations as well as under future laws, rules and regulations and amendments to such laws, rules and regulations to include but not be limited to the express grant of authority to personal representatives as provided by Regulation Section 164.502(g) of Title 45 of the Code of Federal Regulations and the medical information privacy law and regulations generally referred to as HIPAA. Executed at Hall County, Nebraska on August / 7 , 2010. (/Q/! ...V!/ f f 1 7CLP t�C.� Verna C. Kiesling 2