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Public Act 91-0240
HB0404 Enrolled LRB9101374DJcd
AN ACT to amend the Illinois Power of Attorney Act by
changing Section 4-10.
Be it enacted by the People of the State of Illinois,
represented in the General Assembly:
Section 5. The Illinois Power of Attorney Act is
amended by changing Section 4-10 as follows:
(755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
Sec. 4-10. Statutory short form power of attorney for
health care. (a) The following form (sometimes also referred
to in this Act as the "statutory health care power") may be
used to grant an agent powers with respect to the principal's
own health care; but the statutory health care power is not
intended to be exclusive nor to cover delegation of a
parent's power to control the health care of a minor child,
and no provision of this Article shall be construed to
invalidate or bar use by the principal of any other or
different form of power of attorney for health care.
Nonstatutory health care powers must be executed by the
principal, designate the agent and the agent's powers, and
comply with Section 4-5 of this Article, but they need not be
witnessed or conform in any other respect to the statutory
health care power. When a power of attorney in substantially
the following form is used, including the "notice" paragraph
at the beginning in capital letters, it shall have the
meaning and effect prescribed in this Act. The statutory
health care power may be included in or combined with any
other form of power of attorney governing property or other
matters.
"ILLINOIS STATUTORY SHORT FORM POWER OF ATTORNEY FOR
HEALTH CARE
(NOTICE: THE PURPOSE OF THIS POWER OF ATTORNEY IS TO
GIVE THE PERSON YOU DESIGNATE (YOUR "AGENT") BROAD POWERS TO
MAKE HEALTH CARE DECISIONS FOR YOU, INCLUDING POWER TO
REQUIRE, CONSENT TO OR WITHDRAW ANY TYPE OF PERSONAL CARE OR
MEDICAL TREATMENT FOR ANY PHYSICAL OR MENTAL CONDITION AND TO
ADMIT YOU TO OR DISCHARGE YOU FROM ANY HOSPITAL, HOME OR
OTHER INSTITUTION. THIS FORM DOES NOT IMPOSE A DUTY ON YOUR
AGENT TO EXERCISE GRANTED POWERS; BUT WHEN POWERS ARE
EXERCISED, YOUR AGENT WILL HAVE TO USE DUE CARE TO ACT FOR
YOUR BENEFIT AND IN ACCORDANCE WITH THIS FORM AND KEEP A
RECORD OF RECEIPTS, DISBURSEMENTS AND SIGNIFICANT ACTIONS
TAKEN AS AGENT. A COURT CAN TAKE AWAY THE POWERS OF YOUR
AGENT IF IT FINDS THE AGENT IS NOT ACTING PROPERLY. YOU MAY
NAME SUCCESSOR AGENTS UNDER THIS FORM BUT NOT CO-AGENTS, AND
NO HEALTH CARE PROVIDER MAY BE NAMED. UNLESS YOU EXPRESSLY
LIMIT THE DURATION OF THIS POWER IN THE MANNER PROVIDED
BELOW, UNTIL YOU REVOKE THIS POWER OR A COURT ACTING ON YOUR
BEHALF TERMINATES IT, YOUR AGENT MAY EXERCISE THE POWERS
GIVEN HERE THROUGHOUT YOUR LIFETIME, EVEN AFTER YOU BECOME
DISABLED. THE POWERS YOU GIVE YOUR AGENT, YOUR RIGHT TO
REVOKE THOSE POWERS AND THE PENALTIES FOR VIOLATING THE LAW
ARE EXPLAINED MORE FULLY IN SECTIONS 4-5, 4-6, 4-9 AND
4-10(b) OF THE ILLINOIS "POWERS OF ATTORNEY FOR HEALTH CARE
LAW" OF WHICH THIS FORM IS A PART (SEE THE BACK OF THIS
FORM). THAT LAW EXPRESSLY PERMITS THE USE OF ANY DIFFERENT
FORM OF POWER OF ATTORNEY YOU MAY DESIRE. IF THERE IS
ANYTHING ABOUT THIS FORM THAT YOU DO NOT UNDERSTAND, YOU
SHOULD ASK A LAWYER TO EXPLAIN IT TO YOU.)
POWER OF ATTORNEY made this .......................day of
................................
(month) (year)
1. I, ..................................................,
(insert name and address of principal)
hereby appoint:
............................................................
(insert name and address of agent)
as my attorney-in-fact (my "agent") to act for me and in my
name (in any way I could act in person) to make any and all
decisions for me concerning my personal care, medical
treatment, hospitalization and health care and to require,
withhold or withdraw any type of medical treatment or
procedure, even though my death may ensue. My agent shall
have the same access to my medical records that I have,
including the right to disclose the contents to others. My
agent shall also have full power to make a disposition of any
part or all of my body for medical purposes, authorize an
autopsy and direct the disposition of my remains. Effective
upon my death, my agent has the full power to make an
anatomical gift of the following (initial one):
....Any organ.
....Specific organs:................................
(THE ABOVE GRANT OF POWER IS INTENDED TO BE AS BROAD AS
POSSIBLE SO THAT YOUR AGENT WILL HAVE AUTHORITY TO MAKE ANY
DECISION YOU COULD MAKE TO OBTAIN OR TERMINATE ANY TYPE OF
HEALTH CARE, INCLUDING WITHDRAWAL OF FOOD AND WATER AND OTHER
LIFE-SUSTAINING MEASURES, IF YOUR AGENT BELIEVES SUCH ACTION
WOULD BE CONSISTENT WITH YOUR INTENT AND DESIRES. IF YOU
WISH TO LIMIT THE SCOPE OF YOUR AGENT'S POWERS OR PRESCRIBE
SPECIAL RULES OR LIMIT THE POWER TO MAKE AN ANATOMICAL GIFT,
AUTHORIZE AUTOPSY OR DISPOSE OF REMAINS, YOU MAY DO SO IN THE
FOLLOWING PARAGRAPHS.)
2. The powers granted above shall not include the
following powers or shall be subject to the following rules
or limitations (here you may include any specific limitations
you deem appropriate, such as: your own definition of when
life-sustaining measures should be withheld; a direction to
continue food and fluids or life-sustaining treatment in all
events; or instructions to refuse any specific types of
treatment that are inconsistent with your religious beliefs
or unacceptable to you for any other reason, such as blood
transfusion, electro-convulsive therapy, amputation,
psychosurgery, voluntary admission to a mental institution,
etc.): ......................................................
.............................................................
.............................................................
.............................................................
.............................................................
(THE SUBJECT OF LIFE-SUSTAINING TREATMENT IS OF PARTICULAR
IMPORTANCE. FOR YOUR CONVENIENCE IN DEALING WITH THAT
SUBJECT, SOME GENERAL STATEMENTS CONCERNING THE WITHHOLDING
OR REMOVAL OF LIFE-SUSTAINING TREATMENT ARE SET FORTH BELOW.
IF YOU AGREE WITH ONE OF THESE STATEMENTS, YOU MAY INITIAL
THAT STATEMENT; BUT DO NOT INITIAL MORE THAN ONE):
I do not want my life to be prolonged nor do I want
life-sustaining treatment 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, the expense involved and the quality as well as
the possible extension of my life in making decisions
concerning life-sustaining treatment.
Initialed...........................
I want my life to be prolonged and I want life-sustaining
treatment to be provided or continued unless I am in a coma
which my attending physician believes to be irreversible, in
accordance with reasonable medical standards at the time of
reference. If and when I have suffered irreversible coma, I
want life-sustaining treatment to be withheld or
discontinued.
Initialed...........................
I want my life to be prolonged to the greatest extent
possible without regard to my condition, the chances I have
for recovery or the cost of the procedures.
Initialed...........................
(THIS POWER OF ATTORNEY MAY BE AMENDED OR REVOKED BY YOU IN
THE MANNER PROVIDED IN SECTION 4-6 OF THE ILLINOIS "POWERS OF
ATTORNEY FOR HEALTH CARE LAW" (SEE THE BACK OF THIS FORM).
ABSENT AMENDMENT OR REVOCATION, THE AUTHORITY GRANTED IN THIS
POWER OF ATTORNEY WILL BECOME EFFECTIVE AT THE TIME THIS
POWER IS SIGNED AND WILL CONTINUE UNTIL YOUR DEATH, AND
BEYOND IF ANATOMICAL GIFT, AUTOPSY OR DISPOSITION OF REMAINS
IS AUTHORIZED, UNLESS A LIMITATION ON THE BEGINNING DATE OR
DURATION IS MADE BY INITIALING AND COMPLETING EITHER OR BOTH
OF THE FOLLOWING:)
3. ( ) This power of attorney shall become effective on
.............................................................
.............................................................
(insert a future date or event during your lifetime, such as
court determination of your disability, when you want this
power to first take effect)
4. ( ) This power of attorney shall terminate on ......
.............................................................
(insert a future date or event, such as court determination
of your disability, when you want this power to terminate
prior to your death)
(IF YOU WISH TO NAME SUCCESSOR AGENTS, INSERT THE NAMES AND
ADDRESSES OF SUCH SUCCESSORS IN THE FOLLOWING PARAGRAPH.)
5. If any agent named by me shall die, become
incompetent, resign, refuse to accept the office of agent or
be unavailable, I name the following (each to act alone and
successively, in the order named) as successors to such
agent:
.............................................................
.............................................................
For purposes of this paragraph 5, a person shall be
considered to be incompetent if and while the person is a
minor or an adjudicated incompetent or disabled person or the
person is unable to give prompt and intelligent consideration
to health care matters, as certified by a licensed physician.
(IF YOU WISH TO NAME YOUR AGENT AS GUARDIAN OF YOUR PERSON,
IN THE EVENT A COURT DECIDES THAT ONE SHOULD BE APPOINTED,
YOU MAY, BUT ARE NOT REQUIRED TO, DO SO BY RETAINING THE
FOLLOWING PARAGRAPH. THE COURT WILL APPOINT YOUR AGENT IF
THE COURT FINDS THAT SUCH APPOINTMENT WILL SERVE YOUR BEST
INTERESTS AND WELFARE. STRIKE OUT PARAGRAPH 6 IF YOU DO NOT
WANT YOUR AGENT TO ACT AS GUARDIAN.)
6. If a guardian of my person is to be appointed, I
nominate the agent acting under this power of attorney as
such guardian, to serve without bond or security.
7. I am fully informed as to all the contents of this
form and understand the full import of this grant of powers
to my agent.
Signed..............................
(principal)
The principal has had an opportunity to read the above
form and has signed the form or acknowledged his or her
signature or mark on the form in my presence.
.......................... Residing at.......................
(witness)
(YOU MAY, BUT ARE NOT REQUIRED TO, REQUEST YOUR AGENT AND
SUCCESSOR AGENTS TO PROVIDE SPECIMEN SIGNATURES BELOW. IF
YOU INCLUDE SPECIMEN SIGNATURES IN THIS POWER OF ATTORNEY,
YOU MUST COMPLETE THE CERTIFICATION OPPOSITE THE SIGNATURES
OF THE AGENTS.)
Specimen signatures of I certify that the signatures of my
agent (and successors). agent (and successors) are correct.
.......................... .................................
(agent) (principal)
.......................... .................................
(successor agent) (principal)
.......................... .................................
(successor agent) (principal)"
(b) The statutory short form power of attorney for
health care (the "statutory health care power") authorizes
the agent to make any and all health care decisions on behalf
of the principal which the principal could make if present
and under no disability, subject to any limitations on the
granted powers that appear on the face of the form, to be
exercised in such manner as the agent deems consistent with
the intent and desires of the principal. The agent will be
under no duty to exercise granted powers or to assume control
of or responsibility for the principal's health care; but
when granted powers are exercised, the agent will be required
to use due care to act for the benefit of the principal in
accordance with the terms of the statutory health care power
and will be liable for negligent exercise. The agent may
act in person or through others reasonably employed by the
agent for that purpose but may not delegate authority to make
health care decisions. The agent may sign and deliver all
instruments, negotiate and enter into all agreements and do
all other acts reasonably necessary to implement the exercise
of the powers granted to the agent. Without limiting the
generality of the foregoing, the statutory health care power
shall include the following powers, subject to any
limitations appearing on the face of the form:
(1) The agent is authorized to give consent to and
authorize or refuse, or to withhold or withdraw consent to,
any and all types of medical care, treatment or procedures
relating to the physical or mental health of the principal,
including any medication program, surgical procedures,
life-sustaining treatment or provision of food and fluids for
the principal.
(2) The agent is authorized to admit the principal to or
discharge the principal from any and all types of hospitals,
institutions, homes, residential or nursing facilities,
treatment centers and other health care institutions
providing personal care or treatment for any type of physical
or mental condition. The agent shall have the same right to
visit the principal in the hospital or other institution as
is granted to a spouse or adult child of the principal, any
rule of the institution to the contrary notwithstanding.
(3) The agent is authorized to contract for any and all
types of health care services and facilities in the name of
and on behalf of the principal and to bind the principal to
pay for all such services and facilities, and to have and
exercise those powers over the principal's property as are
authorized under the statutory property power, to the extent
the agent deems necessary to pay health care costs; and the
agent shall not be personally liable for any services or care
contracted for on behalf of the principal.
(4) At the principal's expense and subject to reasonable
rules of the health care provider to prevent disruption of
the principal's health care, the agent shall have the same
right the principal has to examine and copy and consent to
disclosure of all the principal's medical records that the
agent deems relevant to the exercise of the agent's powers,
whether the records relate to mental health or any other
medical condition and whether they are in the possession of
or maintained by any physician, psychiatrist, psychologist,
therapist, hospital, nursing home or other health care
provider.
(5) The agent is authorized: to direct that an autopsy
be made pursuant to Section 2 of "An Act in relation to
autopsy of dead bodies", approved August 13, 1965, including
all amendments; to make a disposition of any part or all of
the principal's body pursuant to the Uniform Anatomical Gift
Act, as now or hereafter amended; and to direct the
disposition of the principal's remains.
(Source: P.A. 86-736.)
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