1997 Minnesota Statutes

     145C.05 Suggested form. 

    Subdivision 1.    Content.  A durable power of attorney 
 for health care executed pursuant to this chapter may, but need 
 not, be in the following form: 

    "I appoint .......... as my agent (my attorney in fact) to 
 make any health care decision for me when, in the judgment of my 
 attending physician, I am unable to make or communicate the 
 decision myself and my agent consents to make or communicate the 
 decision on my behalf. 

    My agent has the power to make any health care decision for 
 me.  This power includes the power to give consent, to refuse 
 consent, or to withdraw consent to any care, treatment, service, 
 or procedure to maintain, diagnose, or treat my physical or 
 mental condition, including giving me food or water by 
 artificial means.  My agent has the power, where consistent with 
 the laws of this state, to make a health care decision to 
 withhold or stop health care necessary to keep me alive.  It is 
 my intention that my agent or any alternative agent has a 
 personal obligation to me to make health care decisions for me 
 consistent with my expressed wishes.  I understand, however, 
 that my agent or any alternative agent has no legal duty to act. 

    My agent and any alternative agents have consented to act 
 as my agent.  My agent and any alternative agents have been 
 notified that they will be nominated as a guardian or 
 conservator for me. 

    My agent must act consistently with my desires as stated in 
 this document or as otherwise made known by me to my agent. 

    My agent has the same right as I would have to receive, 
 review, and obtain copies of my medical records and to consent 
 to disclosure of those records." 

    Subd. 2.    Additional provisions.  The durable power of 
 attorney for health care may include additional provisions 
 consistent with this chapter, including: 

    (1) the designation of one or more alternative agents to 
 act if the named agent is unable, unavailable, or unwilling to 
 serve; 

    (2) specific instructions to the agent or any alternative 
 agents; 

    (3) limitations, if any, on the right of the agent or any 
 alternative agents to receive, review, obtain copies of, and 
 consent to the disclosure of the principal's medical records; 

    (4) limitations, if any, on the nomination of the agent as 
 guardian or conservator for purposes of section 525.544; and 

    (5) a document of gift for the purpose of making an 
 anatomical gift, as set forth in sections 525.921 to 525.9224, 
 or an amendment to, revocation of, or refusal to make an 
 anatomical gift. 

    HIST: 1993 c 312 s 6; 1995 c 211 s 2