Page 3526 - Week 12 - Wednesday, 12 October 1994
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If you give a power of attorney under the Powers of Attorney Act 1956 after you have filled in this form, this form will no longer have any effect.".
Page 9, line 5, (Form 1), clause 1, after "that", insert ", in relation to my current condition (describe current condition)".
Page 9, line 31, (Form 2), before clause 1, insert the following:
"IMPORTANT NOTICE:
This form will allow your chosen attorney (who must be over 18) to make certain medical decisions for you if you become incapable of making those decisions yourself.
This form allows your attorney to make decisions about withholding or withdrawing medical treatment.
You can provide that this is to include medical treatment generally, or you can specify a particular kind of treatment which you wish to be withheld or withdrawn.
To create a power of attorney this form must be signed and dated either by you or by another person you have asked to sign and date the form for you. If you ask another person to sign and date this form for you, they should do so in your presence. You must also have two (2) witnesses sign the form. The person to whom you are giving the power of attorney, or any of that person's relatives, cannot be witnesses.
If you have previously given a power of attorney under the Powers of Attorney Act 1956, that power might be affected by filling out this form. You should note that the power to make decisions relating to the withholding or withdrawal of medical treatment will now be exercised according to your instructions on this form and not the form you previously filled in under the Powers of Attorney Act 1956.
If you give a power of attorney under the Powers of Attorney Act l956 after you have filled in this form, this form will no longer have any effect.
Before signing this form, you should read it carefully.".
Page 9, line 34, (Form 2), clause 1, omit "incompetent", substitute "incapacitated".
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