Medical Durable Power Of Attorney
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State here any desires concerning life-sustaining procedures, treatment, general care and services, including any special provisions or limitations: Name of Alternate Agent 1 Agent’s Best Contact Telephone Number Agent’s email or alternative telephone number Agent’s home address Name of Alternate Agent 2 Agent’s Best Contact Telephone Number Agent’s email or alternative telephone number My signature below indicates that I understand the purpose and effect of this document: Agent’s home address Signature of Declarant Pursuant to Colorado Revised Statute 15-14.503–509 Date 1 ADDENDUM TO MEDICAL DURABLE POWER OF ATTORNEY – RECOMMENDED, NOT REQUIRED 1..
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