Free Hawaii Medical Power of Attorney Form - PDF Form Download
Hawaii Health-Care Decisions Act, Hawaii Rev. Stat. §§327E-1 to 327E-16 permits you to execute Hawaii Medical Power of Attorney and/or Preparing Will To Live Durable Power Of Attorney. Execution of such legal document permits the agent to take health care decisions on your behalf especially when you are incapacitated to do so.
This document remains in force forever until you revoke it by executing a revocation instrument. You must specify the terms precisely to avoid ambiguity. Two witnesses or a notary public of Hawaii State must acknowledge your signature and identity pursuant to Hawaii Revised Statutes §710-102. Please handover a copy of this signed document to your health care provider to retain in your medical records.
Steps To Prepare Hawaii Medical Power Of Attorney
- Enter your name, address, and phone number in the foremost portion of the Hawaii Power of Attorney for Health Care Will to Live form.
- Enter name, address, and phone number of agent on the succeeding lines.
- Enter name, address, and phone number of the first alternate agent if you decide to appoint. Similarly provide details of the second alternate agent in case you want to appoint so.
- Mark the box to permit immediate execution of Hawaii Medical Power Of Attorney.
- Type the name of a nominated guardian in case the court wants to appoint a guardian on your behalf.
- Please provide precise instructions to withhold or withdraw lifesaving treatment/s in case your death is imminent. You must strike out unused lines.
- Please provide specific instructions pertaining to lifesaving treatment/s in case you are terminally ill. Please cross off remaining blank lines.
- Please specify any other special conditions and instructions in the space reserved for the same. Please review the instructions carefully to avoid terms that may cause ambiguity and misinterpret your decisions and instructions. Please strike out remaining blank lines to prevent misuse.
- Sign in the section Special Instructions for Pregnancy of the Hawaii Medical Power Of Attorney and/or Preparing Will To Live Durable Power Of Attorney to provide precise directives to the appointed agent and the health care provider in the event you are pregnant and may require lifesaving procedures to allow the child to be born alive.
- Please enter the date, your printed name, and sign in the space before two witnesses or a notary public of Hawaii State. You signing this form also declare that each copy of this Hawaii Medical Power Of Attorney has the same effect like the original.
- Your both witnesses must acknowledge and sign on this form under penalty of false swearing as directed in Hawaii Revised Statutes, §710-102 along with entering their printed name, address, and date.
- Alternately, you may choose to sign before a notary public of Hawaii State and get your identity and signature acknowledged from him/her on this Hawaii Medical Power Of Attorney.