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Page 4 of 5 201801673 me based upon any treatment choices that I have expressed while competent, whether under this document or otherwise. if my attorney cannot determine the treatment choice I would want made under the circumstances, then my-attorney should make such choice for me based upon what my attorney believes to be in my best interests, taking into account the provisions of this document and any information given to my attorney by the physicians treating me as to any medical diagnosis and prognosis, and the intrusiveness, pain, risks, and side effects associated with any proposed treatment or course of action. Accordingly, my attorney is authorized as follows: (a) Treatment. To consent, refuse consent, or withdraw consent to any care, treatment, service, or procedure, including surgery, to maintain, diagnose or treat a physical or mental condition. (b) Withdrawal of Medical Treatment. To require withdrawal of any medical treatment or procedure, including the withdrawal of life - sustaining procedures Initiated in an emergency situation. (c) Health Care Facilities. To admit and make necessary arrangements at any hospital, psychiatric hospital, or psychiatric treatment facility, hospice, nursing home or similar institution, and to assure that all my essential needs are provided for at such a facility; as well as to withdraw or discharge me from such facility, even if such withdrawal or dischargers against the advice of medical professionals. (d) Records and Information. To request, receive and review any information, verbal or written, regarding my personal affairs or physical or mental health, including medical and hospital records; to execute any releases or other documents that may be required in order to obtain such information; to 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; and to disclose such information to such persons or entities as my attorney shall deem appropriate. (e) Grant Releases. To grant, in conjunction with any Instructions given under this power of attorney, releases to hospital staff, physicians, nurses and other medical and hospital administrative personnel who act in reliance on Instructions given by my attorney or who render written opinions to my attorney In connection with any matter described in this power of attorney from all liability for damages suffered or to be suffered by me, and to sign documents titled or purporting to be a "Refusal to Consent To Treatment" and "Leaving Hospital Against Medical Advice" as well as any necessary waivers of or releases from liability required by a hospital or physician to implement my wishes regarding medical treatment or non- treatment.