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<br />_ � -F .' , .:; Fr' 'y- �l`t,,- ,a..� . �"`� `r � Y'���� r� .: .�. .�- ,r_�-f;,_.---==_.— r. —
<br /> _ � 4"� `–wL:.f..v. C- - c >��, � _�..�.–.,. . �L�`�" ,f�
<br /> m� .o– _ . . . ��,µ ..
<br /> �S'�'f
<br /> . ' �ti-�
<br /> . • ._. �M�_.�::_
<br />- -- �• " _ -- — �o° QP A'STSlRNHY `°� ;���$�w� `�_.
<br /> . i SC.:..
<br /> {��'F.-"
<br /> sn,,�c ..�F�t''J..�'•-.
<br /> :ti-;`:-�-
<br /> Qaadye 1►• Sakes, a resident o1 Ssll County, HebreeRe, ; �; .,,,
<br /> herein�tter r�ferred to as Psinoipal, desirinq and int�n8ing to t;:"'..
<br /> �, � eata�l ish a Psnm�nt Dtarable 8avsr oi pl4tornoy operaeiva undQr V'r•._
<br /> � Articla 15 oi Ctempter 49 0! tha Nebsa9ka ReviQO�StDaniel�H.� ��2� �..
<br /> � hezeby appoinC, constituce, an� 8QOi9�ato �► �: ..f" .
<br /> .�� heYQinaQt z0ro£arr�a 4o aa Agant�s, tAsej��tolynnd esuek7►qents and �,:�..
<br /> ��
<br /> �°,^;.
<br /> � attorneys-ic�-faat fos Qrinci�alt an� �inc�pai does here y F F*�
<br /> furthes provida as ioliovs= ��_"�.'_��..
<br /> � a. pdnolpal heseDy coni�r�upan an� grantsot.or q�ntas r'= y",
<br /> • pJenety pover. vi'thout li�itati�n. Said pienaty p �
<br /> conditioned, ho�evar, upan tt�e Aganta aperating and acting under ��^.
<br /> !?;'a,�s.
<br /> � ' ihie Qawer o! 1lttorney onty by snfl through their urtanicous �"
<br />.�;,,.� `. agreesea�t and consont� �8�� ��l�ieQoverahsettiaTiheif►�Ciso �___-
<br />`';��.' on behalf oi Mina�pn l 1 =�-
<br /> ,�%k," 5 prtEale 15 ot Chapter 49 of the Nebraake ReviR ArBtotacLBas�ond F'�='===
<br />, :';'�';�:;t g�nqrally and univorsally tha a►tithosity aad po and evetytAfng . �'""�"�
<br />� � to be an elter cgo 04 �o pr�Q�?�a ss to anything
<br /> � �cae Svily Mithin the ecoRe oP £iiea9 eauaaraied qenesol p�►era, �.:,�
<br /> � � ' ffi�c� (�11) to the full Essten� Px��iaable the powes and suthority, --
<br /> �.� <:'f. wkUrc�vsQ reserva2lon or sesPa�c�fen+ �o do or omit to do any net �t-.
<br /> `'����� :�z gos as on treit�i ot the P����d��� e competent person covl� ---_
<br /> � � 8c e� amit tra, cQo on h�a os Dcr avns 6s2haYf.
<br /> ; 6s2
<br />';, '"' '` m� mentali incapable -
<br /> ;,;f�;,.. �. E£� mR bny t� S ai p��siwlly Y -�.
<br /> a �FZTi.�sl eoneent to sedfrcel treatment, includ£asg
<br />::� ;:�,.:• cE `��`s3.s�'g $�as ut� o{?3a�ian thaC �dlccsl. -
<br />'_�:�.,n1°; �*J•+��'E► � m iicensed physicfo�e cy
<br />..`�;;:'-; �eduses should De Fe��ena�s2 �s�nr me beforo � �o+r� ��;:
<br /> ;.�i art ruim*3Sra.'c�.S{kt+ ' ability �c cxL.�ue my co:s'sent. then my . ,
<br /> ''!k� • a� C.LS'talp r.m�..°�ain my ��-,
<br /> �,•% ��+surneys-i:�-L�ct shali Rave ttsa auA�ority to consent � �►e�icar
<br /> tr7at�ent or &ns�erSi =e��"�°�s8 �'9 a licensed physicfr.r.tr. �;,
<br /> r -
<br /> � � Haweves, I want i� fatown that I do not desire to have m� lifa
<br /> � artifieiaily prolonged if I aw not able to eflectively �: •�
<br /> . communicate with ay faaily and a�y eo�a= an8 if there ie no
<br /> :-::i�;�,�'t.. , seasontsble expeata�ion that I �►fiLt �ecover 8ram eny conditios� nnd �__
<br /> )��•� , thereatter Ise ebie to live vittECS�.�a��totinciude f�d;ingatubea,' ,
<br />;=ty�;,,; �. Bt,rnort. � fm,h.ene ^artifialal r�tl�st
<br /> ,�,y�k� � sQ^piratoax� Ir�sct eny other davieors�, vE�aether now knosm afr invented r
<br /> � �ter.�Ater, c�'ir�aigned to he o uutasQfitd�.t:ra for a vital hufivr.ts. bo�y ��,`�,f.,
<br />��, � �;:ri�of��.
<br /> , .�:,� fui.ir�L�.en. �'.�4��'�?`;
<br /> • Accozd3�s31Y. �e authorit� �� �y a�'���'�-in-f�c! to " ° � ,*�
<br /> �',:_`.
<br /> consent to.we�licai trealment etus�:3t �re�u8e �t� 4eneral the � �_
<br /> 3f
<br /> authority to ratuse mediaal tr�a+�r�t ot anp kind anA the
<br /> , • . specifia authority to 81�aontiaus any astilicial suppost it theza �-°, _
<br /> is no seasonabla oxpeststion that I vili secover isoe any �
<br /> � wnAition end theseattes be abls to live a reasonabiy nor+eel L'i�f•.�s_ �„.._,
<br /> � aitriout the continuing artil�ai�l ouppost.
<br /> • 3� 1►ny provider oi a���ei sssvicea may rely eoncYusively . �
<br /> � � upon sny en8 asa a@aisions, conse�nl�. �ithOre+wala oi con�ent ana �__-.
<br /> directiotts �ade by sy attorn�ys-in-itat under thn cu4�otity _ ,
<br /> contained in �ara9raPh Z• �b°v�• _� eonsidesa��on ot the aedicai —��
<br /> . p:ov9,.��r'r s�lianc� upan th� �ct�onn oi ny attorneys-ia-laet. i
<br /> �.-�,
<br /> heseby cont��t to BoYet�O. lt�d��n�fy �n� �svs harwi�ao ary
<br /> �.�+,.�•• nedicsi prwa'C�'ar wha acMS so selp c! dnA iros any and aii alai*s,
<br /> eemands, suits �nd �auaas ot �ction vhiab arise tro� tAst
<br />� ' proviQer's aats or teiluras to act as a :�aule�o�alsiwinga�e �
<br /> and broaqb! by f� or on *y bahal! os by any p
<br /> '" througt� or une�r a� or as s s�suit of sy aea�h. Tt�i* Qontra is �-���•
<br /> en8 �hall ba tui17� bin�lf�u9 ��n�Y h�i:s, pas�onel saprasenta-
<br /> .�,. •..�•; � tives and �y �stet�. �
<br /> ri�:,,;�.•..:. , . - .�.
<br /> ;�;_.
<br /> '.;=1�����, 1. ' TAis ie a Presenc: Qutinisl:� por+er oY 7►ttosney uh c , _
<br /> �:,;�.t;,JG�g; becones fuily aperative nC. l�a 1:l:o�cc o! its execution by tKo . �:�_`.-�
<br /> �,��;�,,. Drincipal and s�sains o�aurvC�`m �u�nffi rovo4cad. „--• -
<br /> '�+:'. �. � � .
<br /> • � Execute8 ati Grand xal�tna, K��1 County, Nebraska, this �. , �
<br /> ' ;.5�� , •
<br /> };{J.';;�• ,.�� aAy oi January, 1997. . ' . ���.';
<br /> ,�,?' �}I ,;,.
<br /> :,;��'r r���t'. ' �' } s ��s{y� _
<br />`;+f^t������(� . • al�`�cLtiPi A. ekes. na p�rb ��`
<br /> :..�,,:.;
<br /> �' � ST11TE Of EiEBRA81tl1 ) F""'�
<br /> .i.��;if,:� ` (IIOi --..
<br /> ;�i��'y,�: C011NTY OF HALL I �,�
<br /> �•� �Y�, .
<br /> �,�'i.i �A:'
<br /> . . The laregoing instrux�n¢ �� �inaipalgaladye�n. Eakee- �
<br /> �� day oi Januesy, 199]. by �'-
<br /> . E�'ri?
<br /> . Notery 1 a
<br /> � • �q LAW1�D �,_
<br /> 11�0�atr�► fl�'�7 "�.
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