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Article 3 of Chapter 122C of the General Statutes, which you may use to state your instructions regarding mental health treatment in the event you lack sufficient understanding or capacity to make or communicate mental health treatment decisions. Because your health care agent's decisions about decisions must be consistent with any statements you have expressed in an advance instruction, you should indicate here whether you have executed and advance instruction for mental health treatment:

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Health Care Power of Attorney

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4. If you wish to limit the scope of your health care agent's powers, you may do so in this section.)

H.

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3. To request, review, and receive any information, verbal or written, regarding my physical or mental health, including, but not limited to, medical and hospital records, and to consent to the disclosure of this information.

I DESIRE THAT MY LIFE NOT BE PROLONGED BY LIFE SUSTAINING Converse Rainbow High Tops

D.

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E.

If it becomes necessary for a court to appoint a guardian of my person, I nominate my health care agent acting under this document to be the guardian of my person to serve without bond or security. The guardian shall act consistently with G. S. 35A 1201 (a) (5).

B. To employ or discharge my health care providers.

G. Life sustaining procedures are those forms of medical care that only serve to artificially prolong the dying process and may include mechanical ventilation, dialysis, antibiotics, artificial nutrition and hydration, and other forms of medical treatment which sustain, restore or supplant vital bodily functions. Life sustaining procedures do not include care necessary to provide comfort or alleviate pain.

providers.

PROCEDURES IF I AM TERMINALLY ILL, PERMANENTLY IN A COMA, SUFFER SEVERE DEMENTIA, OR AM IN A PERSISTENT VEGETATIVE STATE.

C.

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I. To take any lawful actions that may be necessary to carry out these decisions, including the granting of releases of liability to medical Converse Hi Tops Sale

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A. (Here you may include any specific limitations you deem appropriate such as: your own definition of when life sustaining treatment should be withheld or discontinued, or instructions to refuse any specific types of treatment that are inconsistent with your religious beliefs, or unacceptable to you for any other reason.)B. Notice: This health Converse Shoes Yellow Womens care power of attorney may incorporate or be combined with an advance instruction for mental health treatment, executed in accordance with Part 2 of Converse New Style 2018

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