MINNESOTA HEALTH CARE POWER OF ATTORNEY

(A Health Care Directive pursuant to Minn. Stat. § 145C et seq.)

[// GUIDANCE: Replace all bracketed placeholders (e.g., [PRINCIPAL NAME]) with client-specific data. Delete guidance comments prior to final execution.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block

I. DOCUMENT HEADER

1.1 Title.
This Health Care Power of Attorney (the “Directive”) is executed by [PRINCIPAL NAME] (the “Principal”) pursuant to Minnesota Statutes Chapter 145C (the “Act”).

1.2 Parties.
a. Principal: [PRINCIPAL NAME], residing at [PRINCIPAL ADDRESS].
b. Primary Health Care Agent: [PRIMARY AGENT NAME], residing at [PRIMARY AGENT ADDRESS] (“Primary Agent”).
c. Alternate Health Care Agent(s) (optional):
1. [ALTERNATE AGENT 1 NAME], residing at [ALT. AGENT 1 ADDRESS];
2. [ALTERNATE AGENT 2 NAME], residing at [ALT. AGENT 2 ADDRESS].

1.3 Effective Date.
This Directive becomes effective on the date of execution below and remains effective until revoked in accordance with Section 9.3.

1.4 Governing Law.
This Directive shall be construed and enforced in accordance with the laws of the State of Minnesota, without regard to its conflict-of-laws principles.

II. DEFINITIONS

For purposes of this Directive, capitalized terms have the meanings set forth below:

“Act” means Minn. Stat. ch. 145C, as amended from time to time.

“Best Interest” means a decision that reasonably balances (i) the Principal’s known wishes; (ii) medical prognosis; and (iii) quality-of-life considerations, consistent with accepted medical standards.

“End-of-Life Care” means treatment decisions made when the Principal is in a terminal condition, persistent vegetative state, or other condition described in Section 3.4.

“Good Faith” means honesty in fact and the observance of reasonable medical standards without gross negligence, willful misconduct, or intentional wrongdoing.

“Health Care” has the meaning set forth in Minn. Stat. § 145C.01, subd. 5, and includes mental health treatment.

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations, including 45 C.F.R. § 164.508.

“Principal” has the meaning given in Section 1.2(a).

“Protected Health Information” or “PHI” has the meaning set forth in 45 C.F.R. § 160.103.

III. OPERATIVE PROVISIONS

3.1 Appointment of Health Care Agent.
The Principal hereby appoints the Primary Agent to make all Health Care decisions on the Principal’s behalf whenever the Principal lacks decision-making capacity, as determined under the Act.

3.2 Scope of Authority.
a. General Authority. The Primary Agent may consent to, refuse, or withdraw any Health Care, including life-sustaining treatment, diagnostic testing, surgical procedures, medication, and mental health treatment, subject to the limitations in this Directive.
b. HIPAA Authorization. The Primary Agent is an authorized personal representative for purposes of HIPAA and may receive and disclose PHI to the extent necessary to carry out the duties herein.
c. Post-Death Decisions. The Primary Agent may (i) authorize anatomical gifts; (ii) direct disposition of remains; and (iii) access autopsy records, unless the Principal has made contrary instructions in Section 3.6.

3.3 Decision-Making Standard.
The Primary Agent shall act in Good Faith and in accordance with the Principal’s Known Wishes and Best Interest. Written or oral statements by the Principal regarding Health Care preferences are binding upon the Agent.

3.4 End-of-Life Provisions.
If the Principal is (i) terminally ill with no reasonable expectation of recovery, (ii) in a persistent vegetative state, or (iii) otherwise lacks capacity with irreversible loss of cognitive function, the Principal’s express preference is:
☐ [INITIAL] Comfort-Focused Care Only – withhold or withdraw life-sustaining treatment and artificial nutrition/hydration except as necessary for comfort.
☐ [INITIAL] Full Treatment – provide all medically indicated treatments, including resuscitation, ventilation, and artificial nutrition/hydration.
☐ [INITIAL] Agent Discretion – defer to Agent’s Good Faith judgment.

3.5 Mental Health Treatment (optional).
The Agent is specifically authorized to consent to administration of psychotropic medication, electroconvulsive therapy, and admission to mental health facilities as permitted by law.

3.6 Anatomical Gifts & Disposition of Remains (optional).
☐ [INITIAL] Donate organs/tissues for transplantation.
☐ [INITIAL] Donate body for scientific study.
☐ [INITIAL] Cremation preferred.
☐ [INITIAL] Burial preferred.

3.7 Nomination of Guardian (optional).
If a guardianship is deemed necessary, the Principal nominates the Primary Agent to serve as guardian of the person.

3.8 Instructions to Health-Care Providers.
All providers shall honor this Directive as a valid health-care directive under Minn. Stat. § 145C.06.

IV. REPRESENTATIONS & WARRANTIES

4.1 Principal’s Capacity.
The Principal represents that, on the execution date, the Principal is of sound mind and not under duress or undue influence.

4.2 Agent Qualifications.
Each Agent represents that he or she is (i) at least 18 years of age, (ii) not the Principal’s attending physician or health-care provider, and (iii) willing to serve.

4.3 No Conflicts.
The Principal warrants that no prior advance directive or Durable Power of Attorney for Health Care remains in effect, except as incorporated herein.

V. COVENANTS & RESTRICTIONS

5.1 Agent’s Fiduciary Duties.
The Agent shall (i) act loyally for the Principal’s benefit; (ii) avoid conflicts of interest; and (iii) keep records of all material health-care decisions.

5.2 Prohibited Transactions.
The Agent may not consent to psychosurgery, experimental research, or voluntary sterilization unless expressly authorized in Section 3.5 or 3.6.

5.3 Successor Agent Activation.
If the Primary Agent is unwilling, unable, or disqualified to serve, authority passes to the Alternate Agents in the order listed in Section 1.2(c).

VI. DEFAULT & REMEDIES

6.1 Events of Default.
a. Agent misconduct rising to the level of gross negligence or willful misconduct;
b. Violation of fiduciary duties under Section 5.1.

6.2 Notice & Cure.
Any interested person may deliver written notice specifying alleged misconduct. The Agent shall have five (5) days to respond. Failure to cure permits petition to the Minnesota probate court for removal.

6.3 Remedies.
a. Injunctive Relief. The court may enjoin actions inconsistent with this Directive.
b. Removal & Replacement. The court may remove the Agent and appoint the next qualified Successor Agent.
c. Attorney Fees. The court may award reasonable attorney fees to a prevailing party acting in Good Faith to enforce the Directive.

VII. RISK ALLOCATION

7.1 Indemnification of Agent.
The Principal agrees to indemnify and hold harmless the Agent from any liability, expense, claim, or demand arising from Good-Faith acts or omissions under this Directive, except to the extent resulting from the Agent’s gross negligence or willful misconduct.

7.2 Limitation of Liability.
No Agent shall be civilly or criminally liable for exercising powers in Good Faith pursuant to this Directive and the Act.

7.3 Insurance.
[// GUIDANCE: Insert terms if the Principal maintains liability coverage for the Agent’s benefit.]

7.4 Force Majeure.
No party shall be liable for failure to perform obligations caused by events beyond reasonable control, including but not limited to natural disasters, acts of war, or pandemics.

VIII. DISPUTE RESOLUTION

8.1 Governing Law.
This Directive is governed by the laws of the State of Minnesota.

8.2 Forum Selection.
Exclusive jurisdiction for any proceeding arising under this Directive resides in the state probate court of [COUNTY], Minnesota.

8.3 Arbitration.
Arbitration is not available for disputes under this Directive.

8.4 Jury Waiver.
Not applicable.

8.5 Injunctive Relief.
Nothing herein limits any party’s right to seek injunctive relief to enforce this Directive.

IX. GENERAL PROVISIONS

9.1 Amendment & Revocation.
The Principal may amend or revoke this Directive at any time by (i) a signed writing; (ii) physical destruction with intent to revoke; or (iii) an oral statement in the presence of two (2) witnesses, as provided in Minn. Stat. § 145C.09.

9.2 Assignment & Delegation.
No Agent may delegate authority hereunder without the Principal’s written consent, except to the extent otherwise provided in Section 5.3.

9.3 Successors & Assigns.
This Directive is binding on the Principal’s heirs, executors, administrators, and legal representatives.

9.4 Severability.
If any provision is held unenforceable, the remaining provisions shall remain in full force, and the court shall reform the Directive to effectuate intent.

9.5 Integration.
This Directive constitutes the entire advance directive of the Principal and supersedes all prior inconsistent documents.

9.6 Counterparts & Electronic Signature.
This Directive may be executed in counterparts and by electronic signature, each of which is deemed an original.

X. EXECUTION BLOCK

10.1 Principal’s Signature.

I, [PRINCIPAL NAME], declare that I am of sound mind, understand the contents of this Directive, and sign it freely on this [DAY] day of [MONTH, YEAR].

_______ _______
[PRINCIPAL NAME] Date
10.2 Witness/Notary Requirements (choose ONE):

OPTION A – TWO WITNESSES (not related, not health-care provider, not Agent):

Witness #1 Signature: ____ Date: __
Name & Address: _______

Witness #2 Signature: ____ Date: __
Name & Address: _______
OPTION B – NOTARY PUBLIC:

State of Minnesota )
County of ____ )

On this ___ day of ____, 20__, before me, the undersigned notary public, personally appeared [PRINCIPAL NAME], known to me or satisfactorily proven to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

_______ (Seal)
Notary Public
My Commission Expires: ____
10.3 Agent Acceptance (recommended).

I, [PRIMARY AGENT NAME], accept the appointment as Health Care Agent under this Directive and agree to act in Good Faith.

_______ _______
[PRIMARY AGENT NAME] Date
(Repeat for each Alternate Agent, if desired.)

[// GUIDANCE: Attach optional HIPAA-specific authorization page or include additional mental health treatment instructions if client requests heightened specificity.]