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Contract analysis / health-care-proxy-caldwell.docx
health-care-proxy-caldwell.docx
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Medium · 5
Standard · 0
Section 1: Identification of Principal
Section 1: Identification of Principal I, Jonathan Robert Caldwell, born on March 14, 1956, currently residing at 418 East 72nd Street, Apt. 14A, New York, New York 10021, being an adult of sound mind and acting voluntarily, without duress, fraud, or undue influence of any kind, do hereby make and execute this Health Care Proxy in accordance with the provisions of Article 29-C of the New York Public Health Law (§ 298
Section 2: Appointment of Health Care Agent
Section 2: Appointment of Health Care Agent I hereby appoint the following person as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise in this document: Name of Agent: Eleanor Victoria Caldwell Relationship to Principal: Spouse Address: 418 East 72nd Street, Apt. 14A, New York, New York 10021 Telephone: (212) _-__ My health care agent shall have the aut
Section 3: Appointment of Successor Health Care Agent
Section 3: Appointment of Successor Health Care Agent If my primary health care agent, Eleanor Victoria Caldwell, is unable, unwilling, or unavailable to act as my health care agent — whether by reason of death, incapacity, resignation, refusal, disqualification, or for any other reason — I hereby appoint the following person as my successor health care agent: Name of Successor Agent: Katherine Claire Hartfield Relat
Section 4: Scope of Authority Granted to Agent
Medium
⚑ Liability cap to check against exposure
Section 4: Scope of Authority Granted to Agent The authority granted to my health care agent under this Health Care Proxy shall be broad and shall encompass the power and authority to make any and all health care decisions that I could make for myself if I had the capacity to do so. Without limiting the generality of the foregoing, my health care agent shall have the authority to: (a) Consent to, refuse, or withdraw
Section 5: Statement of Wishes and Instructions
Medium
⚑ Liability cap to check against exposure
Section 5: Statement of Wishes and Instructions In order to provide guidance to my health care agent in the exercise of the authority granted under this Health Care Proxy, I set forth the following statement of my wishes and instructions regarding my health care: (a) General Standard of Care. It is my wish to receive all medically appropriate treatment that is consistent with my comfort and dignity. I value the prese
Section 6: Duration of Proxy
Medium
⚑ Forum / governing law
Section 6: Duration of Proxy This Health Care Proxy shall remain in full force and effect indefinitely from the date of its execution unless and until it is revoked by me in accordance with applicable law. This Health Care Proxy is not affected by my subsequent incapacity. The authority granted to my health care agent under this document is specifically intended to be exercised at a time when I lack the capacity to m
Section 7: Revocation of Prior Health Care Proxies
Section 7: Revocation of Prior Health Care Proxies I hereby revoke any and all prior health care proxies, appointments of health care agents, and similar instruments previously executed by me, whether executed in the State of New York or in any other jurisdiction. This Health Care Proxy supersedes any such prior health care proxy in its entirety, and any person who may have been designated as my health care agent und
Section 8: Reliance by Third Parties
Medium
⚑ Liability cap to check against exposure
Section 8: Reliance by Third Parties Any health care provider, hospital, nursing facility, hospice, insurance company, governmental agency, or other person or institution who acts in good faith reliance upon the authority, decisions, directions, or instructions of my health care agent as designated in this Health Care Proxy shall not be subject to civil or criminal liability, or to professional disciplinary action, f
Section 9: Severability
Section 9: Severability If any provision of this Health Care Proxy, or the application of any provision to any person or circumstance, is held to be invalid, illegal, or unenforceable by any court of competent jurisdiction or any other governmental authority, such invalidity, illegality, or unenforceability shall not affect any other provision of this Health Care Proxy. All remaining provisions shall continue in full
Section 10: Governing Law
Medium
⚑ Forum / governing law
Section 10: Governing Law This Health Care Proxy is executed pursuant to, and shall be governed by and construed in accordance with, Article 29-C of the New York Public Health Law (§ 2981 et seq.) and the laws of the State of New York, without regard to conflict of laws principles. To the extent that this Health Care Proxy is presented for use in a jurisdiction other than the State of New York, I request that it be h
Section 11: Signature of Principal
Section 11: Signature of Principal IN WITNESS WHEREOF, I, Jonathan Robert Caldwell, have executed this Health Care Proxy on the date set forth below, declaring it to be my free and voluntary act. ________________________________________ Jonathan Robert Caldwell Date: April 1, 2023 Address: 418 East 72nd Street, Apt. 14A New York, New York 10021
Section 12: Statement and Signatures of Witnesses
Section 12: Statement and Signatures of Witnesses We, the undersigned witnesses, each being at least eighteen (18) years of age, do hereby attest and declare that the individual who signed this Health Care Proxy, or who asked another to sign this Health Care Proxy on his behalf, did so in our presence on the date set forth below. We further attest that the Principal appeared to be of sound mind and free from duress,
Section 13: Statement and Acknowledgment of Health Care Agent and Successor Health Care Ag
Section 13: Statement and Acknowledgment of Health Care Agent and Successor Health Care Agent Statement of Primary Health Care Agent I, Eleanor Victoria Caldwell, hereby acknowledge that I have been designated as the health care agent for Jonathan Robert Caldwell pursuant to this Health Care Proxy. I understand the nature and scope of the authority granted to me under this document and the obligations attendant to th