Instructions for Executing Durable Power of Attorney for Health Care

(Andre & Blaustein, LLP Format)

1.         You should date the document on page 1 and insert the name of the primary agent and the names of one or two successor agents. 

2.         You should insert any limitations on the grant of authority the Power of Attorney on the lines in Section 3 and write your initials next to those directions.  If you have no restrictions, you should simply insert “none” and initial it. 

3.         You should then initial whichever selection you choose of the three options in Section 3 on page 3 and make any modifications you choose to those provisions. 

4.         You should sign as “principal” on the line provided on page 4. 

5.         Two witnesses should watch you sign and then the witnesses should sign the document (all in the presence of each other) on page 4 and insert their addresses.  Neither witness should be a family member. 

6.         No notary public is required for the Durable Power of Attorney for Health Care.