Revocation Of Health Care Durable Power Of Attorney
Revocation of Health Care Durable Power of Attorney
I, __________________, (“Declarant”), of ____________________________________
(Address), do hereby revoke any and all power and authority granted to my physician, health care provider, or health care agent in the past, but especially the previous Health Care Durable Power Attorney attached in Exhibit 1, and dated _________________, appointing ________________________ to act as my health care Agent. All such Durable Power of Attorney’s, including but not limited to the one named above, are hereby revoked and withdrawn and this document provides notice of such revocation.______________________ ___________________________
Declarant My PhysicianI acknowledge and declare I am not the Declarant’s spouse or heir at the time of witnessing this document, nor am I associated with any health care facility in which Declarant resides or uses in any manner whatsoever.
____________________________
Witness Signature:Witness Name:
Witness Address:
____________________________
Witness Signature:Witness Name:
Witness Address:
Names of institutions/individuals who have been provided a copy of this revocation: Should include all parties receiving prior Agreement and the signatory thereto, “My Physician.”
Revocation of Health Care Durable Power of Attorney
Review ListThis review list is provided to inform you about this document in question and assist you in its preparation. If in doubt, revoke your Health Care Durable Power of Attorney. Make sure that your Revocation accurately identifies the document(s) that you wish to revoke. The full title of each document you are revoking, as stated on the document, should be identified on the Revocation.
Because the attending physician or health care provider must receive notice of the Revocation, it is recommended that the Revocation be mailed by certified mail to the provider’s last known address. Alternatively, a copy of the Revocation may be hand-delivered to the provider, in which case the provider should sign the document acknowledging receipt of the Revocation. The latter is a better solution, all the way around. If Declarant is residing in any health care or other related facility, a copy of the Revocation should be place in his or her Medical file.
1. Make multiple copies so the original attending physician, “My physician,” has a copy as well as for your estate planning file and a separate copy for yourself.
2. Any new Health Care Durable Power of Attorney will supercede the Revocation. However, if you do take this step, you are advised to reference the former Revocation and include it as an exhibit to your new document. Do this to keep your records in order and make sure your directives are followed without document dispute.
Frequently Asked Questions
What is a revocation of health care durable power of attorney?
A revocation of health care durable power of attorney is a legal document used by a declarant to withdraw all previously granted authority to a health care agent, physician, or health care provider. It specifically cancels any prior Health Care Durable Power of Attorney, including the one referenced in the document. This revocation provides formal notice that the earlier power of attorney is no longer in effect.
How do I revoke a health care durable power of attorney?
To revoke a health care durable power of attorney, you must complete a revocation document that identifies you as the declarant, lists your address, and explicitly revokes all past grants of authority. The document should reference the previous power of attorney being revoked, including its date and the name of the agent. It must be signed by you and witnessed according to the instructions in the form.
Who needs to receive a copy of the revocation of health care power of attorney?
The revocation document includes a section to list the names of institutions and individuals who have been provided a copy. This should include all parties who were previously given the original power of attorney, such as your health care agent, physician, and any health care facilities. Providing copies ensures that they are aware the prior document is no longer valid.
Can I revoke a health care durable power of attorney without a lawyer?
The provided document is a self-executing form that allows you to revoke a health care durable power of attorney without necessarily involving a lawyer. It includes fields for your information, the previous agent's details, and witness signatures. However, legal requirements vary by jurisdiction, so consulting a legal professional may be advisable.
What happens if I don't revoke a health care durable power of attorney?
If you do not revoke a health care durable power of attorney, the previously appointed agent may continue to have the authority to make health care decisions on your behalf. This could lead to decisions that no longer align with your current wishes. Revoking the document ensures that the old agent's authority is terminated.
Is a revocation of health care power of attorney legally binding?
Yes, when properly executed, a revocation of health care power of attorney is a legally binding document that withdraws the authority granted in any prior power of attorney. The form includes a declarant's signature and witness attestations to validate the revocation. It serves as formal notice to all relevant parties.
What should be included in a revocation of health care durable power of attorney?
A revocation of health care durable power of attorney should include the declarant's name and address, a clear statement revoking all previous powers of attorney, and specific reference to the prior document being revoked, such as its date and the named agent. It also requires the declarant's signature and witness signatures with names and addresses. Additionally, a section to list institutions and individuals who received a copy is included.
Do I need a witness to revoke a health care power of attorney?
Yes, the revocation document includes a section for witness signatures, names, and addresses. The witness must acknowledge that they are not the declarant's spouse or heir and are not associated with any health care facility where the declarant resides or uses. This witnessing requirement helps ensure the validity of the revocation.
How does a revocation of health care power of attorney affect my previous agent?
A revocation of health care power of attorney immediately withdraws all power and authority granted to your previous health care agent. The agent is no longer authorized to make health care decisions on your behalf. It is important to provide a copy of the revocation to the agent and any relevant institutions to ensure they are aware of the change.
What is the difference between revoking a health care power of attorney and creating a new one?
Revoking a health care power of attorney cancels all existing authority granted to any agent, while creating a new one appoints a new agent with specified powers. The revocation document provided here is used solely to withdraw previous powers and does not appoint a new agent. If you wish to appoint a new agent, you would need to create a new health care durable power of attorney after revoking the old one.
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