Healthcare Power of Attorney

DURABLE HEALTH CARE POWER OF ATTORNEY & ADVANCE DIRECTIVE

(State of Idaho)

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
    A. Appointment and Grant of Authority
    B. End-of-Life Decisions
    C. HIPAA Authorization
    D. Limitations on Agent Authority
    E. Successor Agents
    F. Effectiveness; Durability
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block (Principal • Agent • Witness/Notary)

I. DOCUMENT HEADER

1. Title. DURABLE HEALTH CARE POWER OF ATTORNEY & ADVANCE DIRECTIVE (“Instrument”).
2. Principal. [PRINCIPAL LEGAL NAME], residing at [PRINCIPAL ADDRESS] (“Principal”).
3. Agent. [AGENT LEGAL NAME], residing at [AGENT ADDRESS] (“Agent”).
4. Effective Date. This Instrument is effective on the date of the Principal’s signature below (“Effective Date”).
5. Governing Law. This Instrument is governed by the health-care decision laws of the State of Idaho (“Governing Law”).
6. Consideration. The parties acknowledge mutual promises and the Principal’s reliance on the Agent’s acceptance of the duties herein.

II. DEFINITIONS

For purposes of this Instrument, capitalized terms have the meanings set forth below. Undefined capitalized terms have the meanings assigned by applicable Idaho law.

“Advance Directive” – The instructions contained in Section III.B regarding life-sustaining treatment and end-of-life care.

“Alternate Agent” – Any person designated under Section III.E to act if the Agent is unwilling, unable, or not reasonably available to act.

“Durable” – Surviving the Principal’s incapacity pursuant to Idaho Code § 39-4510.

“Good Faith” – Honesty in fact and the observance of reasonable health-care standards under the circumstances.

“Health Care” – Any care, treatment, service, or procedure to maintain, diagnose, or otherwise affect the Principal’s physical or mental condition.

“HIPAA” – The Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, 45 C.F.R. Parts 160–164.

“Incapacity” – The inability of the Principal to give informed consent, as determined under Idaho Code § 39-4503(4) or any successor statute.

“Life-Sustaining Treatment” – Mechanical ventilation, artificial nutrition and hydration, dialysis, cardiopulmonary resuscitation (“CPR”), or other medical intervention that prolongs life without curing the underlying condition.

“PHI” – Individually identifiable protected health information subject to HIPAA.

“Qualified Witness” – A witness meeting the requirements of Idaho Code § 39-4510(1) and not disqualified under § 39-4510(2).

III. OPERATIVE PROVISIONS

A. Appointment and Grant of Authority

1. Appointment. The Principal hereby appoints the Agent, with full power of substitution subject to Section III.E, to make all Health Care decisions for the Principal during any period of Incapacity.

2. Scope of Authority. Subject to the limitations of Section III.D, the Agent is authorized to:
   a. Give, withhold, or withdraw informed consent to any Health Care;
   b. Employ or discharge Health Care Providers;
   c. Admit or discharge the Principal from any medical facility;
   d. Execute waivers or releases of liability required by a Provider;
   e. Access, review, and disclose medical and insurance records;
   f. Arrange for autopsy, organ donation, and final disposition, consistent with Section III.B.4.

3. Reliance by Third Parties. Any third party may rely on this Instrument as conclusive evidence of the Agent’s authority and Good Faith execution thereof.

B. End-of-Life Decisions

1. General Intent. The Principal desires that decisions about Life-Sustaining Treatment respect the Principal’s dignity, values, and religious or moral beliefs.
2. Directive. If, in the opinion of two (2) qualified physicians, the Principal:
   a. Is terminally ill; or
   b. Is in a persistent vegetative state with no reasonable expectation of recovery,

then the Agent SHALL (check one):
☐ Consent to WITHHOLD or WITHDRAW Life-Sustaining Treatment.
☐ INSIST on all available Life-Sustaining Treatment.
☐ Follow the detailed instructions in Attachment A.

3. Pain Management. Regardless of the above, the Agent may authorize medication or procedures necessary to alleviate pain or provide comfort, even if such measures may hasten death.
4. Organ & Tissue Donation. (Optional) The Agent is authorized to make anatomical gifts pursuant to Idaho Code Title 39, Chapter 34.

C. HIPAA Authorization

1. Authorization. The Principal authorizes any covered entity to disclose PHI to the Agent and Alternate Agent(s) to facilitate Health Care decisions.
2. Purpose. The purpose of this disclosure is to enable the Agent to exercise the authority granted herein.
3. Scope. The authorization applies to all PHI, including mental health, communicable disease, and substance-use records.
4. Expiration. This authorization expires upon the Principal’s death, except to the extent disclosure is necessary to carry out post-death authority granted herein.
5. Revocation. The Principal may revoke this authorization in writing at any time, except to the extent action has already been taken in reliance thereon.

D. Limitations on Agent Authority

1. Statutory Limits. The Agent may not consent to any act prohibited by Idaho Code § 39-4511 or other applicable law, including psychosurgery, abortion, or sterilization.
2. Good Faith Standard. The Agent shall act in Good Faith and in accordance with the Principal’s known wishes or, if unknown, the Principal’s best interests.
3. No Financial Authority. This Instrument confers no authority over the Principal’s financial or property interests.

E. Successor Agents

1. First Alternate Agent: [FIRST ALTERNATE NAME], residing at [ADDRESS].
2. Second Alternate Agent: [SECOND ALTERNATE NAME], residing at [ADDRESS].
3. Sequence. Alternate Agents shall serve in the order listed, each with the same powers as the Agent.

F. Effectiveness; Durability

1. Effectiveness. This Instrument is DURABLE and becomes effective upon the Principal’s Incapacity as certified in writing by a licensed physician or as otherwise provided by law.
2. Termination. This Instrument terminates upon the earliest of:
   a. Written revocation by the Principal;
   b. Appointment of a guardian with express authority over Health Care decisions; or
   c. As otherwise required by law.

IV. REPRESENTATIONS & WARRANTIES

1. Principal. The Principal represents that:
   a. The Principal is at least 18 years old and of sound mind;
   b. Execution of this Instrument is voluntary and free of duress or undue influence.

2. Agent. By signing the Acceptance below, the Agent represents that the Agent:
   a. Is at least 18 years old and legally competent;
   b. Accepts the appointment and fiduciary duties herein;
   c. Is not disqualified under Idaho Code § 39-4510(2).

3. Survival. These representations survive the execution and any partial invalidity of this Instrument.

V. COVENANTS & RESTRICTIONS

1. Standard of Care. The Agent shall act:
   a. In Good Faith;
   b. In accordance with the Principal’s known wishes and religious or moral beliefs; and
   c. Consistently with Idaho Code Title 39, Chapter 45.

2. Consultation. Where practicable, the Agent shall consult with Health Care Providers and family members before making major decisions.

3. Records. The Agent shall maintain reasonable records of significant Health Care decisions and provide copies to interested persons upon request.
4. Conflicts of Interest. The Agent shall avoid self-dealing and promptly disclose any material conflict to the attending physician and interested family members.

VI. DEFAULT & REMEDIES

1. Events of Vacancy or Default. An “Agent Default” occurs if the Agent:
   a. Dies, becomes incapacitated, or resigns;
   b. Is unwilling or not reasonably available to act; or
   c. Is judicially removed for breach of duty.

2. Remedies. Upon an Agent Default, authority automatically passes to the next available Alternate Agent. Any interested person may petition the state probate court for injunctive relief, removal, or appointment of a guardian.

3. Attorney Fees. The prevailing party in any action to enforce or interpret this Instrument is entitled to reasonable attorney fees and costs.

VII. RISK ALLOCATION

1. Indemnification. The Principal shall indemnify and hold harmless the Agent and each Alternate Agent from any loss, liability, or expense arising from actions taken in Good Faith under this Instrument, except for acts or omissions constituting willful misconduct or gross negligence.
2. Limitation of Liability. No Agent shall be liable for monetary damages except for damages proved to result from the Agent’s bad faith, gross negligence, or intentional misconduct.
3. Force Majeure. An Agent is not liable for failure to act due to circumstances beyond the Agent’s reasonable control, including lack of timely medical information or Provider refusal.

VIII. DISPUTE RESOLUTION

1. Governing Law. This Instrument is governed by the substantive laws of the State of Idaho without regard to conflict-of-laws principles.
2. Forum Selection. Any proceeding relating to this Instrument shall be brought exclusively in the district court of the county in Idaho having probate jurisdiction over the Principal’s estate.
3. Injunctive Relief. Nothing herein limits the right of any interested person to seek emergent injunctive relief to enforce the Principal’s Advance Directive or to protect the Principal from irreparable harm.
4. No Arbitration; No Jury Waiver. Consistent with the Parties’ intent and the Instructions provided, this Instrument does not require arbitration or waive the right to a jury trial.

IX. GENERAL PROVISIONS

1. Amendments. The Principal may amend or revoke this Instrument at any time by a signed, dated writing or by physical cancellation, consistent with Idaho Code § 39-4510(4).
2. Severability. If any provision is held invalid, the remaining provisions shall remain in full force to the maximum extent permitted by law.
3. Assignment. The Agent may not delegate authority except to the extent expressly permitted herein or by Idaho law.
4. Integration. This Instrument constitutes the entire agreement regarding Health Care decision-making authority and supersedes prior directives to the extent of conflict.
5. Counterparts; Electronic Signature. This Instrument may be executed in counterparts and by electronic signature, each of which is deemed an original.
6. Delivery of Copies. The Principal directs that executed copies be provided to the Agent, Alternate Agent(s), personal physician, and primary medical facility.

X. EXECUTION BLOCK

A. Principal

I, the undersigned Principal, sign my name to this Durable Health Care Power of Attorney & Advance Directive on the ____ day of __________, 20____.

_______________________________
[PRINCIPAL LEGAL NAME], Principal

B. Agent Acceptance

I accept the appointment as Agent and acknowledge my fiduciary duties.

_______________________________
[AGENT LEGAL NAME], Agent
Date: _________________________

C. Alternate Agent(s) Acceptance (Optional)

1. _____________________________
   [FIRST ALTERNATE NAME]
   Date: ______________________

2. _____________________________
   [SECOND ALTERNATE NAME]
   Date: ______________________

D. NOTARIZATION OR WITNESS ATTESTATION

[Choose ONE of the following formats; delete the unused option.]

OPTION 1 – NOTARY PUBLIC
State of Idaho )
County of ______ ) ss.

On this ____ day of __________, 20____, before me, the undersigned, a Notary Public in and for said State, personally appeared [PRINCIPAL LEGAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to the within instrument, and acknowledged that he/she executed the same for the purposes therein contained.

IN WITNESS WHEREOF, I hereunto set my hand and official seal.

________________________________
Notary Public
My Commission Expires: __________

OPTION 2 – SINGLE QUALIFIED WITNESS
I declare under penalty of perjury that I am at least 18 years old, that I am not the Agent or Alternate Agent, not related to the Principal by blood, marriage, or adoption, not entitled to any part of the Principal’s estate, not responsible for the Principal’s medical bills, and not an employee of the Principal’s Health Care Provider, and that the Principal voluntarily signed this Instrument in my presence.

Witness Signature: ___________________________
Printed Name: _______________________________
Address: ___________________________________
Date: ______________________________________