The South Dakota Medical Power of Attorney form is a legal document that allows an individual to appoint someone else, known as an agent, to make healthcare decisions on their behalf if they are unable to do so. This crucial form provides peace of mind by ensuring that healthcare preferences are respected during times when one cannot express their wishes. To take the first step in securing your healthcare future, consider filling out the form by clicking the button below.
When individuals in South Dakota face the prospect of being unable to make their own healthcare decisions due to illness or incapacity, the South Dakota Medical Power of Attorney form emerges as a pivotal legal document. This form grants a trusted person, known as an agent, the authority to make healthcare decisions on behalf of the principal when they can't do so themselves. It addresses a range of decisions, from routine medical care to more significant interventions like surgery or end-of-life care. Understanding the specifics of this form is crucial, as it involves not just picking a reliable agent, but also delving into personal values and preferences about healthcare. It also necessitates a thorough comprehension of the legal requirements in South Dakota for executing the document to ensure it is valid and enforceable when the need arises. The importance of this document cannot be overstated, as it ensures an individual's healthcare wishes are respected and that decision-making is in the hands of someone they trust deeply.
South Dakota Medical Power of Attorney
This Medical Power of Attorney is established in accordance to the South Dakota Durable Power of Attorney for Health Care Act. It grants the person you designate as your agent the authority to make health care decisions on your behalf should you become unable to do so. Complete this document carefully to ensure your healthcare preferences are respected.
Part 1: Principal Information
Principal's Full Name: _________________
Date of Birth: _________________
Address: _________________
Contact Number: _________________
Part 2: Agent Information
Agent's Full Name: _________________
Relationship to Principal: _________________
Alternate Contact Number: _________________
Part 3: Alternate Agent Information (Optional)
Alternate Agent's Full Name: _________________
Part 4: Powers Granted
This document grants the designated agent the authority to make any and all health care decisions on the principal's behalf that the principal could make, including decisions about the selection or discharge of healthcare providers and institutions, approval or disapproval of diagnostic tests, surgical procedures, and programs of medication.
However, this authority is subject to any statements or limitations provided in Part 5.
Part 5: Special Instructions/Limitations
Please specify any special instructions or limitations on the agent's powers, including any limitations on the power to consent to mental health treatment, life-sustaining treatment, or any other specific wishes concerning treatment that the principal desires or does not desire:
________________________________________________________________
Part 6: Duration
This Medical Power of Attorney will become effective immediately upon execution and shall remain in effect indefinitely unless a specific expiration date or event is listed below:
Expiration Date or Event: _________________
Part 7: Signature
The principal must sign this document and date it in the presence of two witnesses who are not the agent or the alternate agent. Witnesses must be of sound mind and at least 18 years of age.
Principal's Signature: _________________
Date: _________________
Witness 1's Signature: _________________
Witness 2's Signature: _________________
State of South Dakota Acknowledgment
This document was executed in the state of South Dakota and is subject to its laws and regulations. Make sure this Medical Power of Attorney is kept in a safe and accessible place and provide copies to your agent, alternate agent, and healthcare providers.