How to write a Durable Medical Power Of Attorney Form? Download this Durable Medical Power Of Attorney Form template that will perfectly suit your needs.
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(Signature) (Date) (Contract Number) Witnesses: (A witness shall not sign this Durable Power of Attorney unless the person appears to be of sound mind and under no duress, fraud or undue influence.) Names and Addresses of Witnesses: (Witness 1 Name) ( Witness 1 Address) (Witness 1 Signature) (Witness 2 Name) (Witness 2 Address) (Witness 2 Signature) (A witness must be a disinterested individual and may not be the person’s spouse, parent, child, grandchild, sibling, presumptive heir, known devisee at the time of the witnessing, physician, patient advocate, an employee of a life or health insurance provider for the patient, an employee of a health facility that is treating the patient, or an employee of a home for the aged.) WP 11479 AUG 0 DurablePOAHealthcare 0810.
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