Laserfiche WebLink
~~ <br />y , u,, <br />201001801 <br />shall give, withhold, withdraw, or modify such consent for me bald upon any treatment <br />choices that I have expressed while competent, whether under this document or <br />otherwise. If my attorney cannot determine the treatment choice I would want made. under <br />the circumstances, then my attorney should make such choice for me based upon what my <br />attorney believes to be in my best interests, taking into account the provisions of this <br />document and any information given to my aattorney by the physicians treating me as to <br />my medical diagnosis and prognosis, and the intrusiveness, pain, risks, and side effects <br />associated with any proposed treatment or course of action. Accordingly, my attorney is <br />authorized as follows: <br />(a) Treatment. To consent, refuse consent, or withdraw consent to any care, treatment, <br />service, or procedure, including surgery, to maintain, diagnose or treat a physical or <br />mental condition. <br />(b) Withdrawal of Medical Treatment. To require withdrawal of any medical treatment or <br />procedure, including the withdrawal oflife-sustaining procedures initiated in an <br />emergency situation. <br />(c) Health Caze Facilities. Ta admit and and make necessary arrangements at any hospital, <br />psychiatric hospital, or psychiatric treatment facility, hospice, nursing home ar similar <br />institution, and to assure that all my essential needs are provided far at such a facility; as <br />well as ~to withdraw or discharge me from such facility, even if such withdrawal ar <br />discharge is against the advice of medical professionals. <br />(d) Records and Tnfoanation. To request, receive and review any information, verbal or <br />written, regarding my personal affairs or physical or mental health, including medical and <br />hospital records; to execute any releases or other documents that maybe required in order <br />to obtain such information; to waive all privileges which maybe applicable to such <br />information. and records and to any communication pertaining to me and made in the <br />course of any confidential relationship recognized by law; and to disclose such <br />information to such persons or entities as my attorney shall deem appropriate. <br />(e) Grant Releases. To grant, in conjunction with any instructions given under this power <br />of attorney, releases to hospital. staff, physicians, nurses, and other medical and hospital <br />administrative personnel who act in reliance an instructions given by my attorney .or who <br />render written opinions to my attorney in connection with any matter described in this <br />power of attorney from all liability for damges suffered or to be suffered by me, and to <br />sign documents titled or purporting to be a "Refusal to Consent to Treatment" and <br />Leaving Hospital Against Medical Advice" as well as any necessary waivers of or <br />releases from liability required by a hospital or physician to implement my wishes <br />regazding medical treatment ornon-treatment. <br />16. In the event that David J. Mettenbrink for any reason fails, declines, or ceases to <br />serve as my attorney, I designate and appoint Robert L. Mettenbrink Jr. as my attorney in <br />accordance with the terms hereof. <br />Page 4 of 5 <br />