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South Carolina ________________________________________________ _________________________________________________________________ -7- ________________________ Witness No. 2 Signature: _____________________________________ Date: ______________ Print Name: ____________________________ Telephone: _________________ Residence Address: _ate: ______________ Print Name: ____________________________ Telephone: _________________ Residence Address: _________________________________________________ _________________________________________ity in which the principal is a patient. I am not appointed as Health Care Agent or Successor Health Care Agent by this document. -6- Witness No. 1 Signature: _____________________________________ Dlaim against the principal's estate as of this time. I am not the principal's attending physician, nor an employee of the attending physician. No more than one witness is an employee of a health facilion of the principal's estate upon his decease, whether under any will or as an heir by intestate succession, nor am I the beneficiary of an insurance policy on the principal's life, nor do I have a couse, a lineal ancestor, descendant of the parents of the principal, or spouse of any of them. I am not directly financially responsible for the principal's medical care. I am not entitled to any portf Attorney in my presence, and that he/she appears to be of sound mind and under no duress, fraud, or undue influence. I am not related to the principal by blood, marriage, or adoption, either as a sp on the basis of information and belief, that the person who signed or acknowledged this document (the principal) is personally known to me, that he/she signed or acknowledged this Health Care Power o___________________ Name: ____________________________________________________________________ Address: __________________________________________________________________ WITNESS STATEMENT I declare,_______. My current home address is: _______________________________ _________________________________________________________________________ Signature: ______________________________________________HAT I UNDERSTAND THE CONTENTS OF THIS DOCUMENT AND THE EFFECT OF THIS GRANT OF POWERS TO MY AGENT. I sign my name to this Health Care Power of Attorney on this _______ day of ____________, 20_________ealth Care Consent Act, it is my intention that the guardian, Probate Court, or surrogate make those decisions in accordance with my directions as stated in this document. BY SIGNING HERE I INDICATE Tents named herein are unable or unwilling to make decisions concerning my health care, and those decisions are to be made by a guardian, by the Probate Court, or by a surrogate pursuant to the Adult Hr prior power of attorney. B. This power of attorney is intended to be valid in any jurisdiction in which it is presented. 10. UNAVAILABILITY OF AGENT If at any relevant time the Agent or Successor Ag, address, and telephone number of second alternate agent) 9. ADMINISTRATIVE PROVISIONS -5- A. I revoke any prior Health Care Power of Attorney and any provisions relating to health care of any othe____________________________________ (Insert name, address, and telephone number of first alternate agent) B. Second Alternate Agent ______________________________________________________ (Insert namewho is my spouse is divorced or separated from me, I name the following as successors to my agent, each to act alone and successively, in the order named. A. First Alternate Agent ____________________TION NECESSARY FOR COMFORT CARE OR ALLEVIATION OF PAIN BE WITHDRAWN. 8. SUCCESSORS If an agent named by me dies, becomes legally disabled, resigns, refuses to act, becomes unavailable, or if an agent ____ I do want to receive these forms of artificial nutrition and hydration. IF YOU DO NOT INITIAL EITHER OF THE ABOVE STATEMENTS, YOUR AGENT WILL NOT HAVE AUTHORITY TO DIRECT THAT NUTRITION AND HYDRAh to make clear that (INITIAL ONLY ONE) ______ I do not want to receive these forms of artificial nutrition and hydration, and they may be withheld or withdrawn under the conditions given above. OR __E IN MY OWN WORDS: 7. STATEMENT OF DESIRES REGARDING TUBE FEEDING With respect to Nutrition and Hydration provided by means of a nasogastric tube or tube into the stomach, intestines, or veins, I wis the greatest extent possible, within the standards of accepted medical practice, without regard to my condition, the chances I have for recovery, or the cost of the procedures. OR (4) ______ DIRECTIV result in death within a relatively short period of time; or b. if I am in a state of permanent unconsciousness. -4- OR (3) ______ DIRECTIVE FOR MAXIMUM TREATMENT. I want my life to be prolonged to life to be prolonged and I do not want life-sustaining treatment: a. if I have a condition that is incurable or irreversible and, without the administration of life-sustaining procedures, expected toolved and the quality as well as the possible extension of my life in making decisions concerning life-sustaining treatment. OR (2) ______ DIRECTIVE TO WITHHOLD OR WITHDRAW TREATMENT. I do not want my to be provided or continued if my agent believes the burdens of the treatment outweigh the expected benefits. I want my agent to consider the relief of suffering, my personal beliefs, the expense inveatment, I direct the following: (INITIAL ONLY ONE OF THE FOLLOWING 4 PARAGRAPHS) (1) ______ GRANT OF DISCRETION TO AGENT. I do not want my life to be prolonged nor do I want life-sustaining treatment authority to make decisions concerning my health care only in situations to which the Declaration does not apply. 6. STATEMENT OF DESIRES AND SPECIAL PROVISIONS With respect to any Life-Sustaining Trthat if I have a valid Declaration of a Desire for a Natural Death, the instructions contained in the Declaration will be given effect in any situation to which they are applicable. My agent will have_____; may not ______ consent to the donation of all or any of my tissue or organs for purposes of transplantation. 5. EFFECT ON DECLARATION OF A DESIRE FOR A NATURAL DEATH (LIVING WILL) I understand es for the failure to comply. E. The powers granted above do not include the following powers or are subject to the following rules or limitations: 4. ORGAN DONATION (INITIAL ONLY ONE) My agent may _lity against medical advice, and pursuing any legal action in my name, and at the expense of my estate to force compliance with my wishes as determined by my agent, or to seek actual or punitive damag release from liability required by any hospital, physician, nursing care provider, or other health care provider; signing any documents relating to refusals of -3- treatment or the leaving of a facility or service; D. To take any other action necessary to making, documenting, and assuring implementation of decisions concerning my health care, including, but not limited to, granting any waiver oron, or hasten the moment of, but not intentionally cause, my death; C. To authorize my admission to or discharge, even against medical advice, from any hospital, nursing care facility, or similar facid hydration, and cardiopulmonary resuscitation; B. To authorize, or refuse to authorize, any medication or procedure intended to relieve pain, even though such use may lead to physical damage, addicticedures, diagnostic procedures, medication, and the use of mechanical or other procedures that affect any bodily function, including, but not limited to, artificial respiration, nutritional support anccordingly, unless specifically limited by Section E, below, my agent is authorized as follows: A. To consent, refuse, or withdraw consent to any and all types of medical care, treatment, surgical proor me based upon what my agent believes to be in my best interests. My agent's authority to interpret my desires is intended to be as broad as possible, except for any limitations I may state below. A to discuss the proposed decision with me to determine my desires if I am able to communicate in any way. If my agent cannot determine the choice I would want made, then my agent shall make a choice fhealth care. In exercising this authority, my agent shall follow my desires as stated in this document or otherwise expressed by me or known to my agent. In making any decision, my agent shall attemptnd to create a durable power of attorney effective upon, and only during, any period of mental incompetence. 3. AGENT'S POWERS I grant to my agent full authority to make decisions for me regarding my ___________________________________ (home phone) (work phone) as my agent to make health care decisions for me as authorized in this document. 2. EFFECTIVE DATE AND DURABILITY By this document I inte (name of individual you choose as agent) _____________________________________________________________________________ (address) (city) (state) (zip code) __________________________________________ATION OF HEALTH CARE AGENT I, _________________________________________________________, (Principal) hereby appoint: -2- _____________________________________________________________________________ COPY. IF YOU ARE IN A HEALTH CARE FACILITY OR A NURSING CARE FACILITY, A COPY OF THIS DOCUMENT SHOULD BE INCLUDED IN YOUR MEDICAL RECORD. HEALTH CARE POWER OF ATTORNEY (S.C. STATUTORY FORM) 1. DESIGNS A RELATIVE OF YOURS. 8. YOU SHOULD INFORM THE PERSON THAT YOU WANT HIM OR HER TO BE YOUR HEALTH CARE AGENT. YOU SHOULD DISCUSS THIS DOCUMENT WITH YOUR AGENT AND YOUR PHYSICIAN AND GIVE EACH A SIGNEDYOUR DOCTOR OR ANY OTHER HEALTH CARE PROVIDER THAT IS NOW PROVIDING YOU WITH TREATMENT; OR AN EMPLOYEE OF YOUR DOCTOR OR PROVIDER; OR A SPOUSE OF THE DOCTOR, PROVIDER, OR EMPLOYEE; UNLESS THE PERSON I. IF YOU ARE A PATIENT IN A HEALTH FACILITY, NO MORE THAN ONE WITNESS MAY BE AN EMPLOYEE OF THAT FACILITY. 7. YOUR AGENT MUST BE A PERSON WHO IS 18 YEARS OLD OR OLDER AND OF SOUND MIND. IT MAY NOT BE F ATTORNEY AS YOUR AGENT OR SUCCESSOR AGENT. F. YOUR PHYSICIAN OR AN EMPLOYEE OF YOUR PHYSICIAN. G. ANY PERSON WHO WOULD HAVE A CLAIM AGAINST ANY PORTION OF YOUR ESTATE (PERSONS TO WHOM YOU OWE MONEY)N YOUR WILL, OR, IF YOU HAVE NO WILL, WHO WOULD INHERIT YOUR PROPERTY BY INTESTATE SUCCESSION. D. A BENEFICIARY OF A LIFE INSURANCE POLICY ON YOUR LIFE. E. THE PERSONS NAMED IN THE HEALTH CARE POWER OLINEAL ANCESTORS; YOUR SIBLINGS AND THEIR LINEAL DESCENDANTS; OR A SPOUSE OF ANY OF THESE PERSONS. B. A PERSON WHO IS DIRECTLY FINANCIALLY RESPONSIBLE FOR YOUR MEDICAL CARE. C. A PERSON WHO IS NAMED ITHE POWER OF ATTORNEY IS YOURS. THE FOLLOWING PERSONS MAY NOT ACT AS WITNESSES: -1- A. YOUR SPOUSE; YOUR CHILDREN, GRANDCHILDREN, AND OTHER LINEAL DESCENDANTS; YOUR PARENTS, GRANDPARENTS, AND OTHER F ATTORNEY WILL NOT BE VALID UNLESS TWO PERSONS SIGN AS WITNESSES. EACH OF THESE PERSONS MUST EITHER WITNESS YOUR SIGNING OF THE POWER OF ATTORNEY OR WITNESS YOUR ACKNOWLEDGMENT THAT THE SIGNATURE ON H CARE PROVIDER ORALLY OR IN WRITING. 5. IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK A SOCIAL WORKER, LAWYER, OR OTHER PERSON TO EXPLAIN IT TO YOU. 6. THIS POWER OER YOUR OBJECTION IF YOU ARE MENTALLY COMPETENT TO MAKE THAT DECISION. 4. YOU HAVE THE RIGHT TO REVOKE THIS DOCUMENT, AND TERMINATE YOUR AGENT'S AUTHORITY, BY INFORMING EITHER YOUR AGENT OR YOUR HEALTTHIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE HEALTH CARE DECISIONS FOR YOURSELF IF YOU ARE MENTALLY COMPETENT TO DO SO. AFTER YOU HAVE SIGNED THIS DOCUMENT, NO TREATMENT MAY BE GIVEN TO YOU OR STOPPED OVUR AGENT WILL BE OBLIGATED TO FOLLOW YOUR INSTRUCTIONS WHEN MAKING DECISIONS ON YOUR BEHALF. YOU MAY ATTACH ADDITIONAL PAGES IF YOU NEED MORE SPACE TO COMPLETE THE STATEMENT. 3. AFTER YOU HAVE SIGNED JECT TO ANY LIMITATIONS OR STATEMENTS OF YOUR DESIRES THAT YOU INCLUDE IN THIS DOCUMENT. YOU MAY STATE IN THIS DOCUMENT ANY TREATMENT YOU DO NOT DESIRE OR TREATMENT YOU WANT TO BE SURE YOU RECEIVE. YO TO MAKE DECISIONS ABOUT LIFE-SUSTAINING TREATMENT. UNLESS YOU STATE OTHERWISE, YOUR AGENT WILL HAVE THE SAME AUTHORITY TO MAKE DECISIONS ABOUT YOUR HEALTH CARE AS YOU WOULD HAVE. 2. THIS POWER IS SUBSE IMPORTANT FACTS: 1. THIS DOCUMENT GIVES THE PERSON YOU NAME AS YOUR AGENT THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU IF YOU CANNOT MAKE THE DECISION FOR YOURSELF. THIS POWER INCLUDES THE POWER Terms of Use found at findlegalforms.com -7- Power of Attorney for Health Care INFORMATION ABOUT THIS DOCUMENT THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT, YOU SHOULD KNOW THEed with another party. Any possible tax consequences arising out of this document should be discussed with a tax professional. [_] The purchase and use of these forms is subject to the Disclaimers andy first. Before using or signing this document you should have an attorney review it to make sure it fits your particular situation. You should also consult an attorney whenever a document is negotiatbstitute for legal and/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 without consulting with an attornelied or express warranties 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 su care or alleviation of pain be withheld or withdrawn. (D) A health care power of attorney must be substantially in the following form (see form below): [_] These forms are provided "as is" and no impndicate either of the statements in Section 7 concerning provision of artificial nutrition and hydration, the agent does not have authority to direct that nutrition and hydration necessary for comfort not affected by the principal's failure to initial any of the choices provided in Section 4, 6, or 7 of the Health Care Power of Attorney form or to name successor agents. If the principal fails to iesides, or a spouse of the health care provider or employee, unless the health care provider, employee, or spouse is a relative of the principal. (2) The validity of a health care power of attorney isrovider, with whom the principal has a provider-patient relationship at the time the -6- health care power of attorney is executed, or an employee of a nursing care facility in which the principal rnd address of the agent. A health care agent must be an individual who is eighteen years of age or older and of sound mind. A health care agent may not be a health care provider, or an employee of a pprincipal is a patient, no witness is the attending physician or an employee of the attending physician, or no witness has a claim against the principal's estate upon his decease; (d) state the name aincipal; and not appointed as health care agent or successor health care agent in the health care power of attorney; and that no more than one witness is an employee of a health facility in which the tled to any portion of the principal's estate upon his decease under a will of the principal then existing or as an heir by intestate succession; not a beneficiary of a life insurance policy of the pr or adoption, either as a spouse, lineal ancestor, descendant of the parents of the principal, or spouse of any of them; not directly financially responsible for the principal's medical care; not ention (D) of this section that, at the time of the execution of the health care power of attorney, to the extent the witness has knowledge, the witness is not related to the principal by blood, marriage,e signing of the health care power of attorney or the principal's acknowledgment of his signature on the health care power of attorney. Each witness must state in an affidavit as set forth in subsectidated and signed by the principal or in the principal's name by another person in the principal's presence and by his direction; (c) be signed by at least two persons, each of whom witnessed either thtending physician believes the principal may have regained capacity. (C) (1) A health care power of attorney must: (a) be substantially in the form set forth in subsection (D) of this section; (b) be or of extended duration, no further certification is necessary in regard to the stated categories of health care decisions during the stated duration of mental incompetence unless the agent or the atntal incompetence precludes the principal from making all health care decisions or all decisions concerning certain categories of health care, and that the principal's mental incompetence is permanentection 44-66-20(6), except that certification of mental incompetence by the agent may be substituted for certification by a second physician. If the certifying physician states that the principal's mee providers. (4) In determining the effectiveness of a health care power of attorney, mental incompetence is to be determined according to the standards and procedures for inability to consent under S not inconsistent with this section, the provisions of the Adult Health Care Consent Act apply to the making of decisions by a health care agent and the implementation of those decisions by health carrmining that the law applicable to nonconforming durable powers of attorney for health care is the same as the law set forth in this section for health care powers of attorney. -5- (3) To the extentSection 62-5-501 or under the laws of another state does not conform to the requirements of this section, the provisions of this section do not apply to it. However, a court is not precluded from deter of attorney relating to health care pursuant to other provisions of law but which does not conform to the requirements of this section. If a durable power of attorney for health care executed under rs of attorney apply to a health care power of attorney to the extent that they are not inconsistent with this section. (2) This section does not affect the right of a person to execute a durable poweh care power of attorney is a durable power of attorney pursuant to Section 62-5-501. Sections that refer to a durable power of attorney or judicial interpretations of the law relating to durable powettlement agreement; (c) entry of a permanent order of separate maintenance and support or of a permanent order approving a property or marital settlement agreement between the parties. (B) (1) A healthis or her spouse are separated pursuant to one of the following: (a) entry of a pendente lite order in a divorce or separate maintenance action; (b) formal signing of a written property or marital se. (9) "Principal" means an individual who executes a health care power of attorney. A principal must be eighteen years of age or older and of sound mind. (10) "Separated" means that the principal and rtical functioning, but only involuntary vegetative or primitive reflex functions controlled by the brain stem. (8) "Nursing care provider" means a nursing care facility or an employee of the facilityans a medical diagnosis, consistent with accepted standards of medical practice, that a person is in a persistent vegetative state or some other irreversible condition in which the person has no neocoipal shall indicate in the health care power of attorney whether the provision of nutrition and hydration through medically or surgically implanted tubes is desired. (7) "Permanent unconsciousness" men which serves only to prolong the dying process. Life-sustaining procedures do not include -4- the administration of medication or other treatment for comfort care or alleviation of pain. The princ, or corporation licensed, certified, or otherwise authorized or permitted by the laws of this State to administer health care. (6) "Life-sustaining procedure" means a medical procedure or interventios of care. (4) "Health care power of attorney" means a durable power of attorney executed in accordance with this section. (5) "Health care provider" means a person, health care facility, organizationludes the provision of intermediate or skilled nursing care; services for the rehabilitation of injured, disabled, or sick persons; and placement in or removal from a facility that provides these forme with the law of another state. (3) "Health care" means a procedure to diagnose or treat a human disease, ailment, defect, abnormality, or complaint, whether of physical or mental origin. It also incl. (2) "Declaration of a desire for a natural death" or "declaration" means a document executed in accordance with the South Carolina Death with Dignity Act or a similar document executed in accordanc04. Definitions. (A) As used in this section: (1) "Agent" or "health care agent" means an individual designated in a health care power of attorney to make health care decisions on behalf of a principathenticated for record is likewise recordable. (c) This section shall not be construed to alter or affect any provision for revocation or termination contained in the power of attorney. SECTION 62-5-5lusive proof of the nonrevocation or nontermination of the power at that time. If the exercise of the power requires execution and delivery of any instrument which is recordable, the affidavit when aue of doing an act pursuant to the power of attorney, actual knowledge of the revocation or termination of the power of attorney by death, disability, or incompetence, is, in the absence of fraud, concnvalid or unenforceable, binds the principal and his heirs, devisees, and personal representatives. (b) An affidavit, executed by the attorney-in-fact or agent stating that he did not have, at the timother person who, without actual knowledge of the death, disability, or incompetence of the principal, acts in good faith under the power of attorney or agency. Any action so taken, unless otherwise ibility. -3- (a) The death, disability, or incompetence of any principal who has executed a power of attorney in writing does not revoke or terminate the agency as to the attorney-in-fact, agent, or an attorney-in-fact who has received excessive payment may be ordered to make appropriate refunds to the principal. SECTION 62-5-502. Other powers of attorney not revoked until notice of death or disa to agree. (2) An interested person may petition a court of competent jurisdiction to review the propriety and reasonableness of payment for reimbursement or compensation to the attorney-in-fact, and nd (c) if two or more attorneys-in-fact are serving together, the compensation paid must be divided by them in a manner as they agree or as determined by a court of competent jurisdiction if they failthe principal's behalf; (b) an attorney-in-fact, upon the approval of the probate court, is entitled to reasonable compensation based upon the responsibilities he assumed and the effort he expended; arney regarding reimbursement or compensation, or both: (a) an attorney-in-fact is entitled to reimbursement for all reasonable costs and expenses actually incurred and paid by the attorney-in-fact on subsection. (G) (1) An attorney-in-fact is entitled to reimbursement for expenses and compensation for services as provided in the power of attorney. In the absence of a provision in the power of attoe the proper application of assets, funds, or property belonging to the principal. (3) A "third person" means an individual, a corporation, an organization, or other legal entity for purposes of this ttorney-in-fact to exercise authority; (b) is not required to inquire whether the attorney-in-fact has power to act or is properly exercising the power; or (c) is not responsible to determine or ensuris State who receives or is presented with a power of attorney: (a) does not incur liability to the principal or the principal's estate by reason of acting upon the authority of it or permitting the ay-in-fact. (2) Unless the third person actually has received written notice of the revocation or termination of a valid power of attorney executed in accordance with this section, a third person in thorney means to deal with the attorney-in-fact as if the attorney-in-fact were the principal, personally -2- present and acting on his own behalf within the scope of the powers granted to the attornethority, nor is any such person who deals with my attorney-infact responsible to determine or ensure the proper application of funds or property." As used in this subsection, "to honor" a power of atts of my attorneyin-fact for the scope of authority granted to the attorney-in-fact shall incur any liability as to me or to my estate as a result of permitting the attorney-in-fact to exercise this aun or termination, must not refuse to honor the power of attorney if it contains the following provision or a substantially similar provision: "No person who may act in reliance upon the representation4, 1990. (F) (1) A third person in this State who receives or is presented with a valid power of attorney executed pursuant to this section, and has not received actual written notice of its revocatioerly executed durable power of attorney that authorizes an attorney in fact to make health care decisions or other decisions regarding the principal is valid whether or not it was executed after May 1d power of attorney as provided for under this section which is executed in another jurisdiction may be recorded as though it complies with the provisions of subsection (C) of this section. (E) A prop with the law at the time of execution of the jurisdiction where the instrument was executed and it is recorded as required by subsection (C). Notwithstanding the provisions of Section 30-5-30, a vali the instrument is effective without being recorded. (D) A power of attorney as provided for under this section is valid if: (1) executed in compliance with this section; or (2) its execution compliessability or mental incompetence, it is effective notwithstanding the mental incompetence or physical disability. If the authority of the attorney in fact relates solely to the person of the principal,deed in the county where the principal resides at the time the instrument is recorded. After the instrument has been recorded, whether recorded before or after the onset of the principal's physical dins of this section must be executed and attested with the same formality and with the same requirements as to witnesses as a will. In addition, the instrument must be recorded in the same manner as a p, and appointment of a conservator terminates all or part of the power of attorney that relates to matters within the scope of the conservatorship. (C) A power of attorney executed under the provisiorvator appointed. Unless the power of attorney provides otherwise, appointment of a guardian terminates all or part of the power of attorney that relates to matters within the scope of the guardianshisabled or mentally incompetent. The appointment of -1- an attorney in fact under this section does not prevent a person or his representative from applying to the court and having a guardian or consect and provide conditions for their succession, which may include an authorization for the court to appoint a successor, and the succession may occur whether or not the principal then is physically dinal representative as if the principal were alive, mentally competent, and not disabled physically. (B) An instrument to which this section is applicable also may provide for successor attorneys in fay or mental incompetence or uncertainty as to whether the principal is dead or alive have the same effect and inure to the benefit of and bind the principal or his heirs, devisees, legatees, and persoact has a fiduciary relationship with the principal and is accountable and responsible as a fiduciary. All acts done by the attorney in fact pursuant to the power during a period of physical disabilital has or may acquire relating to the principal or any matter, transaction, or property, including the power to consent or withhold consent on behalf of the principal to health care. The attorney in f Care Consent Act. The authority of the attorney in fact to act on behalf of the principal must be set forth in the power and may relate to any act, power, duty, right, or obligation which the principattorney in fact relates solely to health care, mental incompetence is to be determined according to the standards and procedures for inability to consent under Section 44-66-20(6) of the Adult Healthwhether the principal is physically disabled or mentally incompetent. If no definition of mental incompetence or procedures for determining mental incompetence are set forth, and the authority of the f the principal or later uncertainty as to whether the principal is dead or alive. The power may define "physical disability" or "mental incompetence" and may set forth the procedures for determining mental incompetence, the authority of the attorney in fact is exercisable by him as provided in the power on behalf of the principal notwithstanding later physical disability or mental incompetence ol", or (3) similar words showing the intent of the principal that the authority conferred is exercisable notwithstanding his physical disability or mental incompetence or either physical disability orprincipal which renders the principal incapable of managing his own estate", (2) the words "This power of attorney becomes effective upon the physical disability or mental incompetence of the principaates another his attorney in fact by a power of attorney in writing and the writing contains (1) the words "This power of attorney is not affected by physical disability or mental incompetence of the the South Carolina Statutes relating to the South Carolina Power of Attorney for Health Care Form. SECTION 62-5-501. When power of attorney not affected by disability. (A) Whenever a principal designlina Power of Attorney for Health Care Form. This South Carolina Power of Attorney for Health Care is based on South Carolina Statutes Title 62 Section 62-5-101. The following are useful excerpts fromInformation and Instructions South Carolina Power of Attorney for Health Care This package contains (1) Information and Instruction for South Carolina Power of Attorney for Health Care; (2) South Caro South Carolina