MEDICAL POWER OF ATTORNEY
I, Harbans Singh, son/daughter/wife of Late Sh. Gurdev Singh, aged 72 years, of House 12, Sector 40, Chandigarh (the "Principal"), appoint Kiran Kaur, son/daughter/wife of Rajinder Singh, my daughter, of Flat 8, Sector 22, Chandigarh, phone 98140 12345 (the "Agent"), to decide about my medical treatment and care on my behalf, on the terms below.
If the Agent cannot or will not act, I appoint in the Agent's place: Rajinder Singh, son, 98150 54321.
- 1. WHEN THIS STARTS
1.1 This power starts immediately, and it continues if I become unable to decide.
1.2 It continues until I cancel it in writing or I die, and it ends on my death.
- 2. WHAT THE AGENT MAY DO
2.1 The Agent may give or refuse consent to my examination, tests, treatment, medicines and surgery, after speaking with my doctors and weighing my known wishes.
2.2 The Agent may choose or change my doctors and hospital, arrange my admission, transfer and discharge, and sign the hospital's forms for these.
2.3 The Agent may see my medical records and reports, and may talk to my doctors about my condition.
2.4 The Agent may sign the papers needed to claim my health insurance for this treatment, but has no power over my bank accounts, property or any other money matter under this document.
- 3. LIMITS AND WISHES
3.1 The Agent must follow these limits and wishes of mine: No amputation without a second opinion. Follow my Living Will dated 1 March 2026..
- 4. GENERAL
4.1 The Agent will act in my best interests and in line with what I would have wanted, and will tell my close family what is decided.
4.2 I ask all doctors and hospitals to accept this paper as my written wish about who decides for me. I may cancel it at any time while I am able to, by writing and telling the Agent and my doctors.
SIGNING
Signed at Chandigarh on 1 April 2026.
Principal: Harbans Singh
I accept this appointment. Agent: Kiran Kaur
Witness 1 (name, address, signature): ____________________
Witness 2 (name, address, signature): ____________________