HEALTH CARE POWER OF ATTORNEY
(Durable Power of Attorney for Health Care and Advance Directive)
State of Oklahoma
[// GUIDANCE: This template is drafted to comply with the Oklahoma Advance Directive Act, Okla. Stat. tit. 63, §§ 3101.1 et seq. (2023), and related Oklahoma health-care decision statutes. Replace bracketed items with client-specific information and delete all guidance boxes prior to execution.]
TABLE OF CONTENTS
- Document Header
- Definitions
- Operative Provisions
3.1 Appointment of Agent
3.2 Grant of Authority
3.3 End-of-Life Decisions
3.4 HIPAA Authorization
3.5 Organ & Tissue Donation (Optional)
3.6 Nomination of Guardian (Optional) - Representations & Warranties
- Covenants & Restrictions
- Default & Remedies
- Risk Allocation
- Dispute Resolution
- General Provisions
- Execution Block
1. DOCUMENT HEADER
1.1 Title. Health Care Power of Attorney (the “Instrument”).
1.2 Parties.
(a) Principal: [PRINCIPAL LEGAL NAME], of [PRINCIPAL ADDRESS].
(b) Agent: [PRIMARY AGENT NAME], of [PRIMARY AGENT ADDRESS].
(c) Successor Agent(s) (if any): [FIRST SUCCESSOR AGENT NAME]; [SECOND SUCCESSOR AGENT NAME].
1.3 Effective Date. This Instrument is effective on the date executed below (the “Effective Date”) and shall remain in effect until revoked pursuant to Section 5.2.
1.4 Consideration & Intent. For good and valuable consideration, the receipt and sufficiency of which are hereby acknowledged, Principal executes this durable power of attorney for health care to appoint an Agent to make health-care decisions in accordance with Oklahoma law.
1.5 Governing Law. This Instrument shall be governed by and construed in accordance with the laws of the State of Oklahoma, including without limitation the Oklahoma Advance Directive Act and any successor statutes (“State Health-Care Law”).
2. DEFINITIONS
“Advance Directive” means an individual instruction concerning the provision, withholding, or withdrawal of life-sustaining treatment executed in accordance with State Health-Care Law.
“Agent” means the person appointed in Section 3.1, including any Successor Agent who assumes authority under this Instrument.
“Health-Care Decision” means any decision to consent to, refuse, withdraw, or otherwise direct health-care services for Principal, including placement, medication, surgery, diagnostics, palliative care, and end-of-life measures.
“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations at 45 C.F.R. Parts 160 & 164.
“Life-Sustaining Treatment” means any medical procedure, treatment, or intervention that uses mechanical or other artificial means to sustain, restore, or supplant a vital function, including but not limited to artificially administered nutrition and hydration.
“Principal” means the individual executing this Instrument.
“State Probate Court” means the district court of competent probate jurisdiction within the State of Oklahoma.
3. OPERATIVE PROVISIONS
3.1 Appointment of Agent
(a) Principal hereby appoints [PRIMARY AGENT NAME] as Agent to make Health-Care Decisions on Principal’s behalf when Principal lacks capacity or elects to have the Agent act immediately, as indicated below.
(b) Successor Agent(s) shall serve in the order listed in Section 1.2(b) when the then-serving Agent is unwilling, unable, or unavailable to act.
[ ] Check if Agent’s authority is IMMEDIATE.
[ ] Check if Agent’s authority is SPRINGING and begins only upon a physician’s written determination of Principal’s incapacity.
3.2 Grant of Authority
Subject to the limitations expressly set forth herein, Agent is authorized to:
1. Consent to, refuse, or withdraw any Health-Care Decision.
2. Admit or discharge Principal from any health-care facility.
3. Employ or discharge health-care providers.
4. Review and authorize disclosure of medical records pursuant to Section 3.4.
5. Execute documents, waivers, or releases required to obtain or pay for medical care, including insurance benefits.
6. Take any lawful action necessary to implement the intent of this Instrument.
3.3 End-of-Life Decisions
[// GUIDANCE: Oklahoma permits specific instructions regarding life-sustaining treatment. Select the applicable option(s) and delete unused text.]
(a) If I have a terminal condition and my death is imminent, I direct:
[ ] Life-Sustaining Treatment be WITHHELD or WITHDRAWN.
[ ] Life-Sustaining Treatment be PROVIDED.
(b) Artificial Nutrition & Hydration:
[ ] WITHHOLD/REMOVE if they only prolong the process of dying.
[ ] PROVIDE regardless of prognosis.
(c) Pain Relief. I authorize medication in doses necessary to relieve pain or suffering even if such dosage may hasten death.
3.4 HIPAA Authorization
Principal hereby authorizes any physician, health-care professional, hospital, clinic, pharmacy, insurance carrier, or other covered entity to disclose to Agent any protected health information (“PHI”) necessary for Agent to carry out the duties herein. This authorization complies with 45 C.F.R. § 164.508 and shall remain effective until the earlier of (i) revocation pursuant to Section 5.2 or (ii) five (5) years after Principal’s death.
3.5 Organ & Tissue Donation (Optional)
[ ] Principal elects to donate organs and tissues for transplantation/research as permitted by law.
[ ] Principal does NOT wish to donate organs or tissues.
3.6 Nomination of Guardian (Optional)
In the event a court determines the appointment of a guardian is necessary, Principal nominates Agent to serve as guardian of the person. This nomination shall constitute “written nomination” under Okla. law.
4. REPRESENTATIONS & WARRANTIES
4.1 Principal represents that:
(a) Principal is of sound mind, is at least eighteen (18) years of age, and is executing this Instrument voluntarily.
(b) Principal is not subject to undue influence or duress.
4.2 Agent represents, by acceptance below, that Agent:
(a) Is willing and qualified to serve;
(b) Will act in good faith, in Principal’s best interests, and consistently with known wishes of Principal; and
(c) Will keep confidential all PHI except as necessary to exercise authority hereunder.
4.3 Survival. The representations and warranties in this Section 4 shall survive acceptance of authority by Agent and any substitution of a Successor Agent.
5. COVENANTS & RESTRICTIONS
5.1 Agent Duties.
(a) Act consistently with Principal’s expressed instructions and religious or moral beliefs.
(b) Consult, where practicable, with family members and health-care providers.
(c) Maintain contemporaneous records of significant Health-Care Decisions.
5.2 Revocation. Principal may revoke this Instrument in whole or in part at any time by:
1. A signed writing;
2. Personally informing the attending physician; or
3. Any other method permitted under State Health-Care Law.
5.3 Notice Obligations. Agent shall promptly distribute copies of any revocation or amendment to all known health-care providers and interested parties.
6. DEFAULT & REMEDIES
6.1 Removal of Agent. A court of competent jurisdiction may remove an Agent who:
(a) Fails to act in good faith;
(b) Engages in willful misconduct or gross negligence; or
(c) Is adjudicated legally incapacitated.
6.2 Remedies. In addition to statutory remedies, Principal’s estate, family, or any interested party may seek:
(a) Declaratory or injunctive relief to enforce Principal’s wishes;
(b) An accounting of Agent’s actions; and
(c) Damages for losses caused by Agent’s bad-faith conduct.
6.3 Attorneys’ Fees. The prevailing party in any proceeding brought under this Instrument shall be entitled to reasonable attorneys’ fees and costs.
7. RISK ALLOCATION
7.1 Indemnification. Principal agrees to indemnify and hold harmless Agent from any liability, cost, or expense incurred as a result of good-faith actions taken pursuant to this Instrument.
7.2 Limitation of Liability. Agent shall not be liable for any act or omission made in good faith and in substantial compliance with this Instrument and State Health-Care Law.
7.3 Insurance. Agent may, but is not required to, secure liability insurance or surety bonds at the expense of Principal’s estate.
7.4 Force Majeure. Agent shall not be deemed in breach for failure to perform if performance is prevented by war, act of God, epidemic, or other event rendering performance impracticable.
8. DISPUTE RESOLUTION
8.1 Governing Law. See Section 1.5.
8.2 Forum Selection. Exclusive jurisdiction and venue for any proceeding arising under this Instrument shall lie in the State Probate Court of the county where Principal resides or is receiving care.
8.3 Jury Waiver; Arbitration. No provision of this Instrument shall be construed as a waiver of the right to trial by jury, nor does this Instrument provide for arbitration.
8.4 Injunctive Relief. The court may issue temporary, preliminary, or permanent injunctive relief to enforce Health-Care Decisions made pursuant to this Instrument.
9. GENERAL PROVISIONS
9.1 Amendment. Principal may amend this Instrument only by a written instrument executed with the same formalities as this Instrument.
9.2 Assignment. Agent may not delegate authority except to a Successor Agent expressly designated herein.
9.3 Severability. If any provision is held invalid or unenforceable, the remaining provisions shall remain in full force and effect.
9.4 Integration. This Instrument constitutes the entire understanding regarding the subject matter and supersedes all prior powers of attorney for health care executed by Principal.
9.5 Counterparts; Electronic Signatures. This Instrument may be executed in counterparts, each of which shall be deemed an original. Electronic signatures and notarization are permitted to the fullest extent allowed by applicable law.
10. EXECUTION BLOCK
IN WITNESS WHEREOF, Principal has executed this Health Care Power of Attorney on the Effective Date set forth below.
10.1 Principal
Signature: _____
Printed Name: ____
Date: ________
10.2 Acceptance by Agent
I, [PRIMARY AGENT NAME], accept appointment as Agent and agree to act in accordance with this Instrument and Oklahoma law.
Agent Signature: ____
Date: ________
10.3 Witness Attestation
We declare that the Principal is personally known to us, appears to be of sound mind, and under no duress, fraud, or undue influence. We are at least eighteen (18) years of age and are not persons disqualified by law to witness this Instrument.
Witness #1 Signature: ____ Date: __
Printed Name & Address: _______
Witness #2 Signature: ____ Date: __
Printed Name & Address: _______
10.4 Notary Acknowledgment (optional but recommended)
State of Oklahoma )
County of [__] ) ss.
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 herein contained.
Notary Public Signature: ____
My Commission Expires: ____
Commission Number: _________
[// GUIDANCE: Delete either the witness block or the notarization block only if local counsel confirms one method alone satisfies current Oklahoma execution formalities. Many practitioners include both for redundancy.]