Fillable Printable Medical Power of Attorney Form - Wyoming
Fillable Printable Medical Power of Attorney Form - Wyoming
Medical Power of Attorney Form - Wyoming
MEDICAL POWER OF ATTORNEY
STATE OF WYOMING )
) ss.
COUNTY OF __________ )
Know All Men By These Presents that I, ___________________, residing at
_________________, _____________, Wyoming, ________ hereby make, constitute,
and appoint, ____________________my true and lawful attorney in fact for use and in
my name, place and stead, and on our behalf and for my use and benefit as follows:
To obtain medical care for whatever reason as required if I am unable to do so
for myself for whatever reason. ____________________ has the authority to contract
with any physician, hospital, or other type of health facility which is necessary to
provide for the adequate care of myself, ___________________.
The above named individual shall have the authority to complete and sign any
required documentation, authorizations, or release necessary to obtain the requisite
medical care and to otherwise exercise or perform any act, power, duty, right, or
obligation whatsoever that I would have or may be required to exercise or perform to
obtain the necessary medical care for myself if I am unable to do so for any reason.
The above-named individual shall have the power and authority to do, take, and
perform all and every act or thing whatsoever requisite, proper, or necessary to be done
in the exercise of any of the rights and powers herein granted as fully to all extent and
purpose as I might or could do if I were personally capable with full power of
substitution or revocation hereby ratifying and confirming all that said attorney in fact
shall lawfully do or cause to be done by virtue of this Power of Attorney and the rights
and powers herein granted. This medical Power of Attorney in the enumeration of said
specific items, rights, acts, and powers herein is not intended to, nor does it limit or
restrict, and is not to be construed or interpreted as limiting or restricting the medical
powers herein granted to said attorney in fact.
The rights, powers, and authorities of the said attorney in fact herein granted
shall commence on the _______ day of _______, 20___, and such rights, powers, and
authorities shall remain in full force and effect until revoked in writing. By signing
this Medical Power of Attorney I am hereby revoking all previous Medical Power of
Attorneys in whatever form they may be and wherever they may be kept.
DATED this _____________ day of ___________________________, 20___.
_________________________________
___________________
STATE OF WYOMING )
) ss.
COUNTY OF___________ )
SUBSCRIBED AND SWORN to me this _______ day of _____________, 20___,
by ___________________.
WITNESS my hand and official seal.
_______________________________
Notary Public
My commission expires:
