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<br /> 1. i! t.bi� d�u�ant i• r�vok�cl or a�nd�d tor any =
<br /> r�asan. t. �y ulat�, �y lisfr�. �ucca�cors a►ns1 �
<br /> assiqn� will hold any p�cson h3rslaas lros any
<br /> �,�s �y,=lsr�d or l�ability inawcr�d a�s a rssult ot
<br /> such psrson actinq in good� laith upon th�
<br /> . iN�tiiO� o� �Y att o!°iatus�l not3cs�ot aucti �
<br /> r�ipt by such passon
<br /> r�voaat�on or asanc�nt• •
<br /> 3« Tb� pov�� contar�c�d o� aiy :ttorasy� �n laot by
<br /> this daaua�rt aaY b� �s�c�is�d by ay attornsYs in
<br /> !� �� � �y attcrn�Ys in lsct•s 4lqnatur�s
<br /> • os scts u�nda�r th� sutaority grantwd in thf�
<br /> doc�nt ssY b� accapt�d by p�acsons as lully
<br /> suthoris�d by a� and vitti th� saae torao and tant,
<br /> �!l�ct ss i! I vers parsonaily prssant, co�pa
<br /> � a�� � �y � b�ha1! �ux1 shall inwc� to the
<br /> bsn�lit o! and bitW a�, sy s�tat�. �Y h�irs,
<br /> six�ss�oss, �as`igns and psrsonal rsprsasntativ4a.
<br /> 1�. I authoris� all phyricia�ns and psYchiatrista wbo hav4
<br /> tar�at�d a�, asid all ok�ar provid�rs o! h�altb car�,
<br /> includiASj hospitsls, to r�lsis� to ay attorn�ya in tact
<br /> all intaraation or photocoPisa o! any r�cords �rhfch ay
<br /> attornsys iA lact aay s�qu�st. it I aa inca�pstsnt at
<br /> th� tia� ay attor�ya 3ta fact aUall roquest euch
<br /> inlorsation, sll psrsors ar� autaoria�d to trsat aAy
<br /> such r�qu�st !or inloraation by ay attornsya fn laat aa
<br /> ths r�qsu�t o! ay l�qa� rapr�ssnt�tivi and to honor
<br /> such r�qussls1o� tha�basi,�si����.�tbYsuchv�lraatfon
<br /> . .privi3�9+as .��.,.a �...1 � -�------- - - - _ _. ..
<br /> ar�d r�c�ords u�d to say coa�un�r.alion pwctafair�9 to se
<br /> and aad�s in t2� courss ot anY ����tial rslationship
<br /> recognis�d by lav. xy attorn�ys in laat ssy also
<br /> discicsa auch iniaraition to �uch pQraona a� sy
<br /> sttor�ys in•lact sball daaa apprcpria�.
<br /> �� i�y sttorttisys in lact �hall not�incur anY liability to
<br /> ar�, ay �stats, sy luirs, siuxwasors. or assiqns tor
<br /> actinq or r�rafn�.ng lraa actir i f lncs��� ���t !or
<br /> willlu7. aisconduct or 4ro� �9 q
<br /> H. Kotwitbstand3.rq tt�s iar�qoirrg. i �do not vi�h to r�csivs
<br /> tr�t�nt vhich vill nut faprova sy livinq condit�oris
<br /> or ay 3Lralth. I onlY vant tr�at�t, incl�dinq lifs-
<br /> sustatr�t�9 �arsats�nt� t.hat ott�rs banalits to se
<br /> yr�at�r than th� burdsns it will f�poss• in sskincJ
<br />_ thfs d�ciaion_, �y attorr►�ys in fact �hhould consfder
<br /> v�sthsr th� txsata�nt will r�lisv� sutlaring cr fa�+rov�
<br /> �►Y Pr«Jnosis, tbs intrusiv�r�ss o! th� tr�atssnt, ttu
<br /> r1s1�s a�d sid� etlacts it fnvolv�a, whcth�r it wf ll
<br /> �ctanA ay li�e and, it so, what 9ualitY of lif� or
<br /> a�aioysant oi lfts I will ba abla to hava thar�att�r-
<br /> �. '�����.��.+� the Qowors giv�n sy attorrwya in tact
<br /> 1�rafn, ay sttorn�ys in lact �all tollow any oth�r
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