South Carolina Medical Power of Attorney
This Medical Power of Attorney is executed in accordance with the laws of South Carolina. It allows you to designate someone to make medical decisions on your behalf if you are unable to do so.
Principal Information:
- Name: ___________________________
- Address: ___________________________
- City, State, Zip: ___________________________
- Date of Birth: ___________________________
Agent Information:
- Name: ___________________________
- Address: ___________________________
- City, State, Zip: ___________________________
- Phone Number: ___________________________
Effective Date:
This Medical Power of Attorney becomes effective when I am unable to make my own medical decisions as determined by my attending physician.
Limitations:
The authority granted to my agent includes, but is not limited to, the following:
- Making decisions regarding medical treatment.
- Accessing my medical records.
- Consenting to or refusing medical procedures.
Revocation:
This Medical Power of Attorney may be revoked at any time by me, provided that I communicate my intent to revoke to my agent and my healthcare providers.
Signature:
By signing below, I confirm that I am of sound mind and that I voluntarily execute this Medical Power of Attorney.
___________________________
Principal Signature
___________________________
Date
Witnesses:
Two witnesses must sign below, and they cannot be the designated agent.
- ___________________________
Witness 1 Signature
- ___________________________
Witness 2 Signature
___________________________
Date
This document should be kept in a safe place, and copies should be provided to your agent and healthcare providers.