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201807576 <br />of a life-sustaining procedure or artificially administered <br />nutrition or hydration or any other medical treatment from me. <br />Reliance by Provider <br />Any provider of medical services may rely conclusively upon <br />any and all decisions, consents, withdrawals of consent and <br />directions made by my attorney-in-fact under the authority <br />contained in this document. In consideration of the medical <br />provider's reliance upon the actions of my attorney-in-fact, I <br />hereby contract to defend, indemnify and save harmless any <br />medical provider who does so rely of and from any and all claims, <br />demands, suits and causes of action which arise from that <br />provider's intentional acts or intentional failures to act as a <br />result of that reliance and brought by me or on my behalf or by <br />any person claiming by, through or under me or as a result of my <br />death. This contract is and shall be fully binding upon my <br />heirs, personal representatives and my estate. <br />Access to Information <br />I authorize and request any physician, health care <br />professional, health care provider and medical care facility to <br />provide to my Agent information requested by my Agent relating to <br />my physical and mental condition and the diagnosis, prognosis, <br />care and treatment thereof. By this authorization my designated <br />Agent shall be considered as my personal representative under <br />privacy regulations related to protected health information and <br />my designated Agent shall be entitled to all health information <br />in the same manner as if I personally were making the request. <br />This authorization and request shall also be considered a consent <br />to the release of such information under current laws, rules and <br />regulations as well as under future laws, rules and regulations <br />and amendments to such laws, rules and regulations including, but <br />not be limited to, the express grant of authority to personal <br />representatives as provided by Regulation Section 164.502(g) of <br />Title 45 of the Code of Federal Regulations and the medical <br />information privacy law and regulations generally referred to as <br />HIPPA. <br />LONG TERM CARE <br />At the present time I am in good health and able to care for <br />myself. I desire to remain in my own home and under my own care <br />as long as I can do that without causing danger of personal harm <br />to myself or others. I direct that my Agent shall have the <br />exclusive power and authority to decide if and when I should be <br />moved into a long term care facility, as well as the power and <br />3 <br />