$23.95

Add to cart

North Dakota ______________ (Signature of Witness Two) Print Name: ___________________________________ Address: ______________________________________ 4 or long-term care provider giving direct care to the declarant, I must initial this box: [_____]. I certify that the information in (1) through (3) is true and correct _______________________________d the person signing this document to sign on the declarant's behalf. 3 (2) I am at least eighteen years of age. (3) If I am a health care or long-term care provider or an employee of a health care _____ Witness Two: (1) In my presence on _________ (date), _____________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directe1) through (3) is true and correct. _____________________________________________ (Signature of Witness One) Print Name: ___________________________________ Address: _________________________________th care or long-term care provider or an employee of a health care or long-term care provider giving direct care to the declarant, I must initial this box: [_____]. I certify that the information in (s signature on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a healission expires __________________________ , 20__. i. Option 2: Two Witnesses Witness One: (1) In my presence on _________ (date), _____________________ (name of declarant) acknowledged the declarant'e on this document or acknowledged that the declarant directed the person signing this document to sign on the declarant's behalf. ______________________________ (Signature of Notary Public) My comme _______________________________ 2 h. Option 1: Notary Public In my presence on _______________ (date), ____________________________________(name of declarant) acknowledged the declarant's signaturdeclaration. g. I understand that I may revoke this declaration at any time. _____________________________________________________________ (Declarant's Signature) City, County, and State of Residencregnancy. f. I understand the importance of this declaration, I am voluntarily signing this declaration, I am at least eighteen years of age, and I am emotionally and mentally competent to make this lly harmful or would cause unreasonable physical pain. e. If I have been diagnosed as pregnant and that diagnosis is known to my physician, this declaration is not effective during the course of my ptending physician may withhold or withdraw nutrition or hydration if the physician determines that I cannot physically assimilate nutrition or hydration or that nutrition or hydration would be physicamake no statement concerning the administration of hydration. d. Concerning the administration of nutrition and hydration, I understand that if I make no statement about nutrition or hydration, my ation would be physically harmful or would cause unreasonable physical pain, or hydration would only prolong the process of my dying. (3) [________] I do not wish to receive hydration. (4) [________] I n when my death is imminent (initial only one statement): (1) [________] I wish to receive hydration. (2) [________] I wish to receive hydration unless I cannot physically assimilate hydration, hydrat___] I do not wish to receive nutrition. (4) [________] I make no statement concerning the administration of nutrition. c. I have made the following decision concerning the administration of hydratioon unless I cannot physically assimilate nutrition, nutrition would be physically harmful or would cause unreasonable physical pain, or nutrition would only prolong the process of my dying. (3) [_____ng decision concerning the administration of nutrition when my death is imminent (initial only one statement): (1) [________] I wish to receive nutrition. 1 (2) [________] I wish to receive nutritis the final expression of my legal right to direct that medical or surgical treatment be provided. (3) [________] I make no statement concerning life-prolonging treatment. b. I have made the followireversible condition which, without the administration of life-prolonging treatment, will result in my imminent death. It is my intention that this declaration be honored by my family and physicians asal, which is death. (2) [________] I direct that life-prolonging treatment, which could extend my life, be used if two physicians certify that I am in a terminal condition that is an incurable or irention that this declaration be honored by my family and physicians as the final expression of my legal right to refuse medical or surgical treatment and that they accept the consequences of that refu treatment, will result in my imminent death; (b) The application of life-prolonging treatment would serve only to artificially prolong the process of my dying; and (c) I am not pregnant. It is my inthat I be permitted to die naturally if two physicians certify that: (a) I am in a terminal condition that is an incurable or irreversible condition which, without the administration of life-prolongingnth, day, year): a. I have made the following decision concerning life-prolonging treatment (initial 1, 2, or 3): (1) [________] I direct that life-prolonging treatment be withheld or withdrawn and tx professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Living Will DECLARATION I declare on ____________________________(moicular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document should be discussed with a tavary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without consulting an attorney first to make sure it fits your partr are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws physician or other health care provider shall make the revocation a part of the declarant's medical record. [_] These forms are provided "as is" and no implied or express warranties have been made ot's direction; or c. An oral expression of intent to revoke. 2. A revocation is effective upon communication to the attending physician or other health care provider by the declarant. 3. The attendingdeclarant is competent, including by: a. A signed, dated writing; b. Physical cancellation or destruction of the declaration by the declarant or another in the declarant's presence and at the declaranapply to emergency treatment performed in a prehospital situation. 23-06.4-05. Revocation of declaration. 1. A declaration may be revoked at any time and in any manner by the declarant, provided the hholding, or withdrawal of such treatment and must be given great weight by the physic ian in determining the intent of the incompetent declarant. A declaration made under section 23-06.4-03 does not ion made under section 23-06.4-03 does not obligate the physician to use, withhold, or withdraw life-prolonging treatment but is presumptive evidence of the declarant's desires concerning the use, witrant is determined by the attending physician and another physician to be in a terminal condition and no longer able to make decisions regarding administration of life-prolonging treatment. A declarate declarant. Living Will Information & Instructions ­ Page 3 23-06.4-04. When declaration operative. A declaration becomes operative when it is communicated to the attending physician, and the decla or other health care provider who is furnished a copy of the declaration shall make it a part of the declarant's medical record and, if unwilling to comply with the declaration, promptly so advise thctives. Another form may be used if it complies with this chapter. The invalidity of any additional specific directives does not affect the validity of the declaration. (see form below) 3. A physicianicians of the declarant. 2. The following statutory form is a preferred form, but not a required form, by which a person may execute a declaration. The declaration may include additional specific direClaimants against any portion of the estate of the declarant at the time of the execution of the declaration; d. Directly financially responsible for the declarant's medical care; or e. Attending physb. Entitled to any portion of the estate of the declarant under any will of the declarant or codicil to the will or deed, existing by operation of law or otherwise, at the time of the declaration; c. er providing direct care to the declarant on the date of execution. The notary public or any witness may not be: a. The declarant's spouse or related to the declarant by blood, marriage, or adoption; irect care to the declarant. At least one witness to the execution of the declaration must not be a health care provider providing direct care to the declarant or an employee of the health care providrant, either by notary public or by two witnesses who are at least eighteen years of age. A person notarizing the declaration may be an employee of a health care or long-term care provider providing dby the declarant, or another at the declarant's direction, and contain verification of the declarant's signature or the signature of the person directed by the declarant to sign on behalf of the declaighteen or more years of age may execute at any time a declaration governing the use, withholding, or withdrawal of life-prolonging treatment, nutrition, and hydration. The declaration must be signed or physical impairment, including comatose conditions that will not result in imminent death. 23-06.4-03. Declaration relating to use of life-prolonging treatment. 1. An individual of sound mind and e, will result, in the opinion of the attending physician, in imminent death. The term does not include any form of senility, Alzheimer's disease, mental retardation, mental illness, or chronic mental ho has personally examined the patient to be in a terminal condition. 7. "Terminal condition" means an incurable or irreversible condition that, without the administration of life-prolonging treatmentstructions ­ Page 2 6. "Qualified patient" means a patient eighteen or more years of age who has executed a declaratio n and who has been determined by the attending physician and another physician wr intervention performed in an emergency, prehospital situation. 5. "Physician" means an individual licensed to practice medicine in this state pursuant to chapter 43-17. Living Will Information & Ines not include the provision of appropriate nutrition and hydration or the performance of any medical procedure necessary to provide comfort care or alleviate pain; or medical procedures, treatment, oed to a qualified patient, will serve only to prolong the process of dying and where, in the judgment of the attending physician, death will occur whether or not the treatment is utilized. The term doe to administer health care in the ordinary course of business or practice of a profession. 4. "Life-prolonging treatment" means any medical procedure, treatment, or intervention that, when administerexecuted in accordance with the requirements of subsection 1 of section 23-06.4-03. 3. "Health care provider" means a person who is licensed, certified, or otherwise authorized by the law of this statchapter, unless the context otherwise requires: 1. "Attending physician" means the physician who has primary responsibility for the treatment and care of the patient. 2. "Declaration" means a writing mercy killing, euthanasia, or assisted suicide or permit any affirmative or deliberate act or omission to end life other than to permit the natural process of dying. 23-06.4-02. Definitions. In this Communication about such matters is encouraged between each person and the person's family, the physician, and other health care providers. This chapter does not condone, authorize, approve, or permithe decisions relating to the adult's own medical care, including the decision to ha ve medical or surgical means or procedures calculated to prolong the adult's life provided, withheld, or withdrawn. akota Statutes relating to Living Wills. CHAPTER 23-06.4 (UNIFORM RIGHTS OF TERMINALLY ILL ACT) 23-06.4-01. Legislative intent. Every competent adult has the right and the responsibility to control tg Will. This North Dakota Living Will is based on Title 23 Chapter 23-06.4 Section 23-06.4-01 et. Seq. of the North Dakota Code. For your convenience, we have included useful excerpts from the North Dignature of alternate agent/date) -6- Information and Instructions North Dakota Living Will This package contains (1) Information and Instruction for North Dakota Living Will; (2) North Dakota Livinncapable of making the principal's health care decisions, I must notify the principal's physician. ___________________________________ (Signature of agent/date) ___________________________________ (Sr of attorney at any time in any manner. If I choose to withdraw during the time the principal is competent, I must notify the principal of my decision. If I choose to withdraw when the principal is incipal only if the principal becomes incapable. I understand that I must act in good faith in exercising my authority under this power of attorney. I understand that the principal may revoke this powederstand I have a duty to act consistently with the desires of the principal as expressed in this appointment. I understand that this document gives me authority over health care decisions for the priof Witness Two) ____________________________________ (Address) 10. ACCEPTANCE OF APPOINTMENT OF POWER OF ATTORNEY. I accept this appointment and agree to serve as agent for health care decisions. I unrovider giving direct care to the declarant, I must initial this box: [______]. I certify that the information in (1) through (3) is true and correct. ____________________________________ (Signature the declarant directed the person signing this document to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a health care provider or an employee of a health care p_ (Address) Witness Two: (1) In my presence on _________ (date), ____________________________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that tial this box: [______]. I certify that the information in (1) through (3) is true and correct. -5- ____________________________________ (Signature of Witness One) ___________________________________ to sign on the declarant's behalf. (2) I am at least eighteen years of age. (3) If I am a health care provider or an employee of a health care provider giving direct care to the declarant, I must ini__ (date), ____________________________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directed the person signing this document declarant's behalf. _________________________ (Signature of Notary Public) My commission expires __________________________ , 20__. Option 2: Two Witnesses Witness One: (1) In my presence on ______________ (date), ________________ (name of declarant) acknowledged the declarant's signature on this document or acknowledged that the declarant directed the person signing this document to sign on thetitled to inherit any part of your estate upon your death; or 5. A person who has, at the time of executing this document, any claim against your estate. Option 1: Notary Public In my presence on ___the following may be used as a notary or witness: 1. A person you designate as your agent or alternate agent; 2. Your spouse; 3. A person related to you by blood, marriage, or adoption; 4. A person enf the document must not be a health care or long-term care provider providing you with direct care or an employee of the health care or long-term care provider providing you with direct care. None of nessed by two qualified adult witnesses. The person notarizing this document may be an employee of a health care or long-term care provider providing your care. At least one witness to the execution o MUST DATE AND SIGN EACH OF THE ADDITIONAL PAGES AT THE SAME TIME YOU DATE AND SIGN THIS POWER OF ATTORNEY.) -4- NOTARY PUBLIC OR STATEMENT OF WITNESSES This document must be (1) notarized or (2) witY WILL NOT BE VALID UNLESS IT IS NOTARIZED OR SIGNED BY TWO QUALIFIED WITNESSES WHO ARE PRESENT WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IF YOU HAVE ATTACHED ANY ADDITIONAL PAGES TO THIS FORM, YOUAttorney For Health Care on _____________ (date) at _____________________ (city) ______________________ (state) ________________________________________________ (You sign here) (THIS POWER OF ATTORNED. I revoke any prior durable power of attorney for health care. DATE AND SIGNATURE OF PRINCIPAL (YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY) I sign my name to this Statutory Form Durable Power of _________________________________ _________________________________________________________________ (Insert name, address, and telephone number of second alternate agent.) 9. PRIOR DESIGNATIONS REVOKE___________ __________________________________________________________________ (Insert name, address, and telephone number of first alternate agent.) b. Second Alternate Agent: ______________________my agent to make health care decisions for me as authorized in this document, such persons to serve in the order listed below: a. First Alternate Agent: _______________________________________________th care decisions for me, or if I revoke that person's appointment or authority to act as my agent to make health care decisions for me, then I designate and appoint the following persons to serve as er agent.) If the person designated as my agent in paragraph 1 is not available or becomes ineligible to act as my agent to make a health care decision for me or loses the mental capacity to make healIf the agent you designated is your spouse, he or she becomes ineligible to act as your agent if your marriage is dissolved. Your agent may withdraw whether or not you are capable of designating anothernate agent you designate will be able to make the same health care decisions as the agent you designated in paragraph 1, above, in the event that agent is unable or ineligible to act as your agent. is space ONLY if you want the authority of your agent to end on a specific date.) 8. DESIGNATION OF ALTERNATE AGENTS. (You are not required to designate any alternate agents but you may do so. Any alt a shorter period in the space below, this power of attorney will exist until it is revoked.) -3- This durable power of attorney for health care expires on _______________________________ (Fill in the a "Refusal to Permit Treatment" and "Leaving Hospital Against Medical Advice". b. Any necessary waiver or release from liability required by a hospital or physician. 7. DURATION. (Unless you specifyhe health care decisions that my agent is authorized by this document to make, my agent has the power and authority to execute on my behalf all of the following: a. Documents titled or purporting to bour agent to receive and disclose information relating to your health, you must state the limitations in paragraph 4 above.) 6. SIGNING DOCUMENTS, WAIVERS, AND RELEASES. Where necessary to implement txecute on my behalf any releases or other documents that may be required in order to obtain this information. c. Consent to the disclosure of this information. (If you want to limit the authority of ypower and authority to do all of the following: a. Request, review, and receive any information, verbal or written, regarding my physical or mental health, including medical and hospital records. b. Ee chapter 23-06.2, the Uniform Anatomical Gift Act. 5. INSPECTION AND DISCLOSURE OF INFORMATION RELATING TO MY PHYSICAL OR MENTAL HEALTH. Subject to any limitations in this document, my agent has the you must date and sign EACH of the additional pages at the same time you date and sign this document.) If you wish to make a gift of any bodily organ you may do so pursuant to North Dakota Century Cod____ ______________________________________________________________________________ (You may attach additional pages if you need more space to complete your statement. If you attach additional pages, d limitations regarding health care decisions: ______________________________________________________________________________ ________________________________________________________________________________________________________________________________________ ______________________________________________________________________________ b. Additional statement of desires, special provisions, anted below: a. Statement of desires concerning life-prolonging care, treatment, services, and procedures: ______________________________________________________________________________ ________________rcising the authority under this durable power of attorney for health care, my agent shall act consistently with my desires as stated below and is subject to the special provisions and limitations stas in the space below. If you do not state any limits, your agent will have broad powers to make health care decisions for you, except to the extent that there are limits provided by law.) -2- In exef treatment that you do not want to be used, you should state them in the space below. If you want to limit in any other way the authority given your agent by this document, you should state the limites concerning other matters relating to your health care. You can also make your desires known to your agent by discussing your desires with your agent or by some other means. If there are any types o below. You should consider whether you want to include a statement of your desires concerning life-prolonging care, treatment, services, and procedures. You can also include a statement of your desirSPECIAL PROVISIONS, AND LIMITATIONS. (Your agent must make health care decisions that are consistent with your known desires. You can, but are not required to, state your desires in the space providedlth care decisions for you, you can state the limitations in paragraph 4 below. You can indicate your desires by including a statement of your desires in the same paragraph.) 4. STATEMENT OF DESIRES, my agent, including my desires concerning obtaining or refusing or withdrawing life-prolonging care, treatment, services, and procedures. (If you want to limit the authority of your agent to make heamyself if I had the capacity to do so. In exercising this authority, my agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to GRANTED. Subject to any limitations in this document, I hereby grant to my agent full power and authority to make health care decisions for me to the same extent that I could make such decisions for ysical or mental condition. 2. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. By this document I intend to create a durable power of attorney for health care. 3. GENERAL STATEMENT OF AUTHORITYes of this document, "health care decision" means consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's phcare facility, or a nonrelative employee of an operator of a long-term care facility) as my attorney in fact (agent) to make health care decisions for me as authorized in this document. For the purpos decisions for you. None of the following may be designated as your agent: your treating health care provider, a nonrelative employee of your treating health care provider, an operator of a long-term ___________________________________________ _______________________________________________________ (insert name, address, and telephone number of one individual only as your agent to make health care 1. DESIGNATION OF HEALTH CARE AGENT. I, __________________________________ ____________________________________________________ (insert your name and address) do hereby designate and appoint: _______nt where it is immediately available to your agent and alternate agents, if any, or give each of them an executed copy of this document. You should give your doctor an executed copy of this document. you should ask a lawyer to explain it to you. Your agent may need this document immediately in case of an emergency that requires a -1- decision concerning your health care. Either keep this documetnessing procedure described at the end of this form. This document will not be valid unless you comply with the witnessing procedure. If there is anything in this document that you do not understand, and to consent to their disclosure unless you limit this right in this document. This document revokes any prior durable power of attorney for health care. You should carefully read and follow the wi of your agent by notifying your agent or your treating doctor, hospital, or other health care provider orally or in writing of the revocation. Your agent has the right to examine your medical recordsyour best interest. Unless you specify a specific period, this power will exist until you revoke it. Your agent's power and authority ceases upon your death. You have the right to revoke the authorityke health care decisions for you if your agent authorizes anything that is illegal; acts contrary to your known desires; or where your desires are not known, does anything that is clearly contrary to res and any limitation that you include in this document. You may state in this document any types of treatment that you do not desire. In addition, a court can take away the power of your agent to mat for any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition if you are unable to do so yourself. This power is subject to any statement of your desi yourself so long as you can give informed consent with respect to the particular decision. This document gives your agent authority to request, consent to, refuse to consent to, or to withdraw consen to consent to your doctor not giving treatment or stopping treatment necessary to keep you alive. Notwithstanding this document, you have the right to make medical and other health care decisions forr you. Your agent must act consistently with your desires as stated in this document or otherwise made known. Except as you otherwise specify in this document, this document gives your agent the powerst eighteen years of age for this document to be legally valid and binding. This document gives the person you designate as your agent (the attorney in fact) the power to make health care decisions foCUTING THIS DOCUMENT This is an important legal document that is authorized by the general laws of this state. Before executing this document, you should know these important facts: You must be at lea [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com -4- Statutory Form Durable Power Of Attorney For Health Care WARNING TO PERSON EXEation. You should also consult an attorney whenever a document is negotiated with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional.ng point for you and should not be used without consulting with an attorney first. Before using or signing this document you should have an attorney review it to make sure it fits your particular situl effect or completeness. [_]These forms are not intended and are not a substitute for legal and/or tax advice. Laws vary from time to time and from state to state. These forms should only be a startienalties provided by law. [_] These forms are provided "as is" and no implied or express warranties have been made or are provided as to their suitability for any specific purpose or as to their legar of attorney or willfully alters or forges a revocation of a power of attorney is guilty of a class A misdemeanor. 3. The penalties provided in this section do not preclude application of any other pining procedures which hastens the death of the principal is guilty of a class C felony. 2. A person who, without authorization of the principal, willfully alters, forges, conceals, or destroys a powerization of the principal, willfully alters or forges a power of attorney or willfully conceals or destroys a revocation with the intent and effect of causing a withholding or withdrawal of life-susta chapter. 23-06.5-17. Statutory form of durable power of attorney. The statutory form of durable power of attorney is as follows (see form below): 23-06.5-18. Penalties. 1. A person who, without autho durable power of attorney for health care pursuant to this chapter. It is known as "the statutory form of durable power of attorney for health care". Another form may be used if it complies with this. Use of statutory form. The statutory form of durable power of attorney described in section 23-06.5-17 may be used and is the preferred form, but not a required form, by which a person may execute aal records; -3- 2. Execute any releases or other documents which may be required in order to obtain such medical information; and 3. Consent to the disclosure of such medical information. 23-06.5-16may for the purpose of making health care decisions: 1. Request, review, and receive any information, oral or written, regarding the principal's physical or mental health, including medical and hospit.5-08. Inspection and disclosure of medical information. Subject to any limitatio ns set forth in the durable power of attorney for health care by the principal, an agent whose authority is in effect he principal's care of the revocation. 3. If the spouse is the principal's agent, the divorce of the principal and spouse revokes the appointment of the divorced spouse as the principal's agent. 23-06tion of a durable power of attorney for health care shall immediately record the revocation in the principal's medical record and notify the agent, the attending physician, and staff responsible for t. By execution by the principal of a subsequent durable power of attorney for health care. 2. A principal's health care or long-term care services provider who is informed of or provided with a revoca a. By notification by the principal to the agent or a health care or long-term care services provider orally, or in writing, or by any other act evidencing a specific intent to revoke the power; or bnding physician. The attending physician shall cause the withdrawal to be recorded in the principal's medical record. 23-06.5-07. Revocation. 1. A durable power of attorney for health care is revoked:s incapable. Until the principal becomes incapable, the agent may withdraw by giving notice to the principal. After the principal becomes incapable, the agent may withdraw by giving notice to the atteent in writing. Subject to the right of the agent to withdraw, the acceptance creates a duty for the agent to make health care decisions on behalf of the principal at such time as the principal becomeitten by some other person in the principal's presence and at the principal's express direction. 23-06.5-06. Acceptance of appointment - Withdrawal. To be effective, the agent must accept the appointms medical care, or the attending physician of the principal. If the principal is physically unable to sign, the durable power of attorney for health care may be signed by the principal's name being wred in existence or by operation of law, any other person who has, at the time of execution, any claims against the estate of the principal, a person directly financially responsible for the principal'pal's spouse or heir, a person related to the principal by blood, marriage, or adoption, a person entitled to any part of the estate of the principal upon the death of the principal under a will or def a health care or long-term care provider providing direct care to the principal on the date of execution. The notary public or any witness may not be, at the time of execution, the agent, the princioviding direct care to the principal. At least one witness to the execution of the document must not be a health care or long-term care provider providing direct care to the principal or an employee oary public or at least two or more subscribing witnesses who are at least eighteen years of age. A person notarizing -2- the document may be an employee of a health care or long-term care provider pripal's long-term care services provider. 23-06.5-05. Execution and witnesses. The durable power of attorney for health care must be signed by the principal and that signature must be verified by a note of the principal who is an employee of the principal's health care provider; 3. The principal's long-term care services provider; or 4. A nonrelative of the principal who is an employee of the princ.5-04. Restrictions on who can act as agent. A person may not exercise the authority of agent while serving in one of the following capacities: 1. The principal's health care provider; 2. A nonrelativiod of more than forty-five days without a mental health proceeding or other court order, or to psychosur gery, abortion, or sterilization, unless the procedure is first approved by court order. 23-06proposed treatment, or of any proposal to withdraw or withhold treatment. 5. Nothing in this chapter permits an agent to consent to admission to a mental health facility or state institution for a perfied in writing by the principal's attending physician and filed in the principal's medical record. 4. The principal's attending physician shall make reasonable efforts to inform the principal of any the principal's best interests. 3. Under a durable power of attorney for health care, the agent's authority is in effect only when the principal lacks capacity to make health care decisions, as certined in the durable power of attorney for health care or in a declaration executed pursuant to chapter 23-06.4; or b. If the principal's wishes are unknown, in accordance with the agent's assessment of health care providers, the agent shall make health care decisions: a. In accordance with the agent's knowledge of the principal's wishes and religious or moral beliefs, as stated orally, or as contaihealth care, the agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make. 2. After consultation with the attending physician and otherealth care. -1- 23-06.5-03. Scope and duration of authority. 1. Subject to the provisions of this chapter and any express limitations set forth by the principal in the durable power of attorney for care facility" or "long-term care services provider" means a long-term care facility as defined in section 50-10.1-01. 8. "Principal" means an adult who has executed a durable power of attorney for hfacility licensed, certified, or otherwise authorized or permitted by law to administer health care, for profit or otherwise, in the ordinary course of business or professional practice. 7. "Long-termof consent to, or request for any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's physical or mental condition. 6. "Health care provider" means an individual or ating to an agent the authority to make health care decisions executed in accordance with the provisions of this chapter. 5. "Health care decision" means consent to, refusal to consent to, withdrawal f a health care decision, including the significant benefits and harms of and reasonable alternatives to any proposed health care. 4. "Durable power of attorney for health care" means a document delegient, who has primary responsibility for the treatment and care of the patient. 3. "Capacity to make health care decisions" means the ability to understand and appreciate the nature and consequences o an adult to whom authority to make health care decisions is delegated under a durable power of attorney for health care. 2. "Attending physician" means the physician, selected by or assigned to a patfirmative or deliberate act or omission to end life, other than to allow the natural process of dying. 23-06.5-02. Definitions. In this chapter, unless the context otherwise requires: 1. "Agent" means periods of incapacity through the prior designation of an individual to make health care decisions on their behalf. This chapter does not condone, authorize, or approve mercy killing, or permit an afating to the North Dakota Power of Attorney for Health Care Form. 23-06.5-01. Statement of purpose. The purpose of this chapter is to enable adults to retain control over their own medical care duringorth Dakota Power of Attorney for Health Care is based Title 23 Chapter 23-06.5 Section 23-06.5-01 of the on North Dakota Statutes. The following are useful excerpts from the North Dakota Statutes reler of Attorney for Health Care This package contains (1) Information and Instruction for North Dakota Power of Attorney for Health Care; (2) North Dakota Power of Attorney for Health Care Form. This N be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers and Terms of Use found at findlegalforms.com Information and Instructions North Dakota Pow sure it fits your particular situation. Advice from a local attorney is always recommended when dealing with estate planning matters. Any possible tax consequences arising out of this document shouldd/or tax advice. Laws vary from time to time and from state to state. These forms should only be a starting point for you and should not be used or signed without cons ulting an attorney first to makenties have been made or are provided as to their suitability for any specific purpose or as to their legal effect or completeness. [_]These forms are not intended and are not a substitute for legal an an Advance Health Care Directive. The first form is the Power of Attorney for Health Care and the second form is the Living Will. [_] These forms are provided "as is" and no implied or express warraNorth Dakota Advance Health Care Directive This package contains both a North Dakota Power of Attorney for Health Care and a North Dakota Living Will. Together these forms are also sometimes known as North Dakota