GENERAL POWER OF ATTORNEY

		KNOW EVERYONE BY THESE PRESENTS, which are intended to constitute a Durable General Power of Attorney, THAT I, _______________________________, having an address at _______________________, hereby make, constitute and appoint 	_______________________________________, having an address at	______________________________, or if he/she is unable, unwilling or unavailable to act, then 	_____________________________, or if he/she unable, unwilling or unavailable to act, then 	____________________________,  as my attorney-in-fact TO ACT in my name, place and stead in any way which I could do, if I were personally present, to the extent that I am permitted by law to act through an agent:  

(a)  to ask, demand, sue for, recover and receive all manner of goods, chattels, debts, rents, interest, sums of money and demands whatsoever, due or to become due, that are thought to be owing, belonging or payable to me in my own right or otherwise, and to execute, acknowledge and deliver acquittances, receipts, releases, satisfactions or other discharges for the same; 

(b)  to sell, transfer, exchange, convert, abandon, or otherwise dispose of, or grant options with respect to, real and personal property, at public or private sale, with or without security, in such manner, at such times, for such prices, and upon such terms and conditions as my attorney-in-fact may deem necessary or appropriate; 

(c)  to buy, sell, exchange, invest and reinvest in common or preferred stocks, bonds, commodities, options, limited liability companies, investment trusts, mutual funds, regulated investment companies and other types of securities and financial instruments, foreign or domestic, including any undivided interest in any one or more common trust funds, whether or not such investments be of the character permissible for investments by fiduciaries under any applicable law, and without regard to the effect any such investment may have upon the diversity of investments; to demand, receive and obtain any money or other things of value to which I am or may become or may claim to be entitled in connection with any stocks, bonds or other financial instruments; to cause securities or other property to be held or registered in the name of a nominee or nominees or unregistered or in any other form; to vote in person at meetings of stock or security holders and adjournments thereof, to enter into voting trusts, and to vote by general or limited proxy with respect to any stock or securities; 

(d)  to make, execute, endorse, accept and deliver in my name or in the name of my attorney-in-fact all checks, notes, drafts, warrants, securities, stock certificates, certificates of deposit, bonds, acknowledgments, and any other agreements, certificates or instruments of any nature, as my attorney-in-fact may deem necessary or appropriate; 

(e)  to deposit and withdraw any sums to or from any bank, savings or similar account maintained by me alone or jointly; to open, continue, modify or terminate any account or banking arrangement in my name or jointly with others; to borrow money at such interest rates and upon such terms and conditions as my attorney-in-fact may deem necessary or appropriate, and to provide security therefor from my assets; to pay, renew or extend the time of payment of any note given by me or on my behalf; to prepare financial statements concerning my assets and liabilities or income and expenses, and deliver them to financial institutions; to receive statements, notices and other documents from financial institutions; to open or cause to be opened any safe deposit box in my name and to examine and remove any or all of the contents of such box; and to conduct such other banking transactions as my attorney-in-fact may deem necessary or appropriate; 

(f)  to take possession of, recover, obtain and hold any tangible personal property belonging to me or to which I may be entitled, and to receive and take for me and in my name any rents, issues and profits of any such property; to purchase, invest in, reinvest in, accept as a gift, sell, exchange, lease, grant options upon, assign, transfer, abandon, pledge, encumber or otherwise dispose of any personal property of any nature and wherever situate; to store property for hire or on a gratuitous bailment; to make repairs and alterations; and to execute, acknowledge and deliver all contracts, leases, notes, security agreements, guarantees, bills of sale, assignments, extensions, releases, waivers, consents, and any other agreements, writings and instruments of any nature affecting any personal property, as my attorney-in-fact may deem necessary or appropriate; 

(g)  to possess, recover, manage, hold, control, develop, subdivide, partition, mortgage, lease or otherwise deal with any real property belonging to me or to which I may be entitled; to purchase, invest in, reinvest in, accept as a gift, sell, exchange, lease, sublease, grant options upon, convey with or without covenants, quitclaim, assign, transfer, abandon, encumber or otherwise dispose of any real property of any nature and wherever situate; to borrow money at such interest rates and upon such terms and conditions as my attorney-in-fact may deem necessary or appropriate, and to provide security therefor by mortgage or pledge of any property; to satisfy, discharge, release or extend the term of any mortgage; to apply for zoning, rezoning or other governmental permits; to make repairs, replacements and improvements, structural or otherwise; to pay, compromise or contest real estate taxes, assessments, water charges and sewer rents; to abstain from the payment of real estate taxes, assessments, water charges and sewer rents, repairs, maintenance and upkeep of the same; to abandon property if deemed to be worthless or not of sufficient value to warrant keeping or protecting; to permit property to be lost by tax sale, foreclosure or other proceeding or to convey property for a nominal consideration or without consideration; and to execute, acknowledge and deliver all contracts, deeds, leases, mortgages, notes, security agreements, guarantees, transfers to trusts, bills of sale, assignments, extensions, satisfactions, releases, waivers, consents, and any other agreements, writings and instruments of any nature affecting any real property, as my attorney-in-fact may deem necessary or appropriate; 

(h)  to commence any actions or proceedings for the recovery of any real or personal property or for any other purpose; to appear in, answer and defend any actions or proceedings commenced against me; and to prosecute, maintain, appeal, discontinue, compromise, arbitrate, mediate, settle and adjust all actions, proceedings, accounts, dues and demands that now or hereafter may exist, as my attorney-in-fact may deem necessary or appropriate; 

(i)  to create, amend or terminate one or more trusts, partnerships, corporations, limited liability companies, co-tenancies or any other form of ownership or entity for the purpose of dealing with any property or property interest of any nature that I may have or hereafter acquire, under such terms and with such provisions as my attorney-in-fact may deem necessary or appropriate; to transfer any or all property in which I have an interest into any trusts, partnerships, corporations, limited liability companies, co-tenancies or other entities, whether created by me or my attorney-in-fact or otherwise (and, in this regard, that my attorney-in-fact may be a remainderman, partner, shareholder, member, co-tenant or beneficiary of any such entity shall not affect the validity of any action hereunder, and shall not, by itself, constitute a breach of fiduciary duty); to remove property from any such entity; and to give to any such entity, or to any person acting as agent or trustee under any instrument executed by me or on my behalf, such instructions or authorizations as I may have the right to give; 

(j)  to join or become a party to, or to oppose, any reorganization, readjustment, recapitalization, foreclosure, merger, voting trust, dissolution, consolidation or exchange, and to deposit any securities with any committee, depository or trustee, and to pay any fees, expenses and assessments incurred in connection therewith, and to charge the same to principal, and to exercise conversion, subscription or other rights, and to make any necessary payments in connection therewith, or to sell any such privileges; 

(k)  to deal with all matters relating to all forms of insurance and annuities, including the procurement, maintenance and termination thereof; however, notwithstanding the powers given my attorney-in-fact in this and other provisions of this power of attorney, my attorney-in-fact shall have no incidents of ownership in any life insurance policy in which I own an interest and which insures the life of my attorney-in-fact; 

(l)  to do all acts necessary to maintain my customary standard of living and that of my family and other persons customarily supported by me, including without limitation the power to pay for medical, dental and surgical care, living quarters, usual vacation and travel expenses, shelter, clothing, food, education, organizational fees and contributions, and other living costs; 

(m)  to act for me in all matters which affect my right to government benefits and assistance, including without limitation Social Security, Medicare, Medicaid, qualified state tuition programs, and other governmental benefits and benefits relating to civil or military service; to file, prosecute, submit to arbitration or settle any claim for benefits or assistance; to establish new residency and domicile; and to receive the proceeds of claims and conserve, invest, disburse and use them on my behalf; 

(n)  to take all steps and remedies necessary or appropriate for the conduct and management of any business in which I may have an interest; to exercise in person or by proxy any right, privilege or option which I may have with respect to any business; to continue, modify, negotiate, renegotiate, extend and terminate any and all contracts or agreements heretofore or hereafter made with respect to the business; to pay, compromise or contest business taxes or other claims or obligations; to determine the policies of the business as to the location, methods and manner of its operations including its financing, accounting, and insurance; and to add or remove capital from the business; 

(o)  to employ such agents, attorneys, accountants, investment counsel, trustees, caretakers and other persons and entities providing services or advice, irrespective of whether my attorney-in-fact may be associated therewith, and to rely upon information or advice furnished thereby or to ignore the same, and to delegate duties hereunder and pay such compensation, as my attorney-in-fact may deem necessary or appropriate; and 

(p)  to do, execute, perform and finish for me and in my name all things which my attorney-in-fact shall deem necessary or appropriate in and about or concerning my property or any part thereof.  

		This power of attorney is a durable power of attorney, and it shall not be affected by physical disability or mental incompetence which renders me incapable of managing my own estate.  It is my intent that the authority conferred herein shall be exercisable notwithstanding my physical disability or mental incompetence.  

		It may be necessary for my attorney-in-fact to have access to my medical records to establish whether medical bills are valid and appropriate or for other purposes.  I grant to my attorney-in-fact the authority and power to serve as my personal representative for all purposes of the Health Insurance Portability and Accountability Act of 1996, the regulations in 45 C.F.R. Sec. 160 et seq., and any other applicable federal, state or local laws or regulations (collectively "HIPAA"), including the authority to request, receive, obtain and review, and be granted full and unlimited access to, and consent to the disclosure of complete unredacted copies of any and all health, medical and financial information and any information or records referred to in 45 C.F.R. Sec. 164.501 and regulated by the Standards for Privacy of Individually Identifiable Health Information found in 65 Fed. Reg. 82462 as protected private records or otherwise covered under HIPAA.  I understand that health and medical records can include information relating to subjects such as sexually transmitted diseases, acquired immunodeficiency syndrome (AIDS), AIDS-related complex (ARC) and human immunodeficiency virus (HIV), behavioral or mental health services, and treatment for alcohol or drug abuse or addiction.  I understand that I may have access to or receive an accounting of the information to be used or disclosed as provided in 45 C.F.R. Sec. 164.524 et seq.  I further understand that authorizing the disclosure of this health information is voluntary and that I can refuse to sign this authorization.  I further understand that any disclosure of this information carries with it the potential for an unauthorized further disclosure of this information by third parties and that such further disclosure may not be protected under HIPAA.  In order to induce the disclosing party to disclose the aforesaid private and/or protected confidential information, I forever release and hold harmless said disclosing party who relies upon this instrument from any liability under confidentiality rules arising under HIPAA as a consequence of said disclosure.  I authorize my attorney-in-fact to execute any and all releases or other documents that may be necessary in order to obtain disclosure of my patient records and other medical information subject to and protected by HIPAA.  

		 It is my desire and request that no guardian or conservator of my person or property be appointed in the event of my disability or incapacity.  If, however, a guardian or conservator of my person or property is to be appointed for me, I hereby nominate and appoint my attorney-in-fact hereunder to serve as guardian and conservator without bond.  

		To induce any third party to act hereunder, I hereby agree that any third party receiving a duly executed copy or facsimile of this power of attorney may act hereunder, and that revocation or termination hereof shall be ineffective as to such third party unless and until actual notice or knowledge of such revocation or termination shall have been received by such third party.  I, for myself and my heirs, executors, legal representatives and assigns, hereby agree to indemnify and hold harmless any such third party from and against any and all claims that may arise against such third party by reason of such third party having relied upon the provisions of this power of attorney.  

		I hereby revoke any prior general powers of attorney which I have executed (but not any powers of attorney related to health care).

		This power of attorney shall be governed by South Carolina law, although I request that it be honored in any state or other location in which I or my property may be found.  If any provisions hereof shall be unenforceable or invalid, such unenforceability or invalidity shall not affect the remaining provisions of this power of attorney.  

		IN WITNESS WHEREOF, I have executed this power of attorney this ____ day of ________________, 2018.
						 SIGNATURE OF TESTATOR: 

______________________________

STATE OF SOUTH CAROLINA

COUNTY OF BEAUFORT		                        ATTESTATION

		The foregoing power of attorney was this _______________________, 2018, signed, sealed, published and declared by  ___________________________, the Principal, as the Principal's appointment and empowerment of an attorney-in-fact, in the presence of us who at the Principal's request and in the Principal's presence and in the presence of each other, have hereunto subscribed our names as witnesses hereto.  

__________________________
     Witness No.1
residing at: 	____________________________________
 
__________________________
     Witness No.2
residing at: 	____________________________________ 

STATE OF SOUTH CAROLINA

COUNTY OF BEAUFORT		                               PROBATE

		Personally appeared before me the undersigned witness, who, being duly sworn, says that (s)he saw the within named ________________________________ sign, seal and as his act and deed deliver the foregoing power of attorney, and that deponent with the other witness whose name is subscribed above witnessed the execution thereof.  

							 _______________________________
								 Witness No.1 or No.2

Subscribed and sworn to before me 
on _____________________, 2018

____________________________
Notary Public for South Carolina
My commission expires on 06-28-2023

LIVING WILL

a/k/a 

DECLARATION OF MY DESIRE FOR A NATURAL DEATH

STATE OF SOUTH CAROLINA

COUNTY OF BEAUFORT

TO:  My family, physicians and all those concerned with my care

		I, ___________________________ (the “Principal”), domiciled in and presently residing at: _______________________________________, and being at least eighteen years of age and of sound mind, make this declaration this ______ day of ________________, 2018. 

		I willfully and voluntarily make known my desire that no life-sustaining procedures be used to prolong my dying if my condition is terminal or if I am in a state of permanent unconsciousness, and I hereby declare:  

		If at any time I should have a condition certified to be a terminal condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death could occur within a reasonably short period of time without the use of life-sustaining procedures or if the physicians certify that I am in a state of permanent unconsciousness, and where the application of life-sustaining procedures would serve only to prolong the dying process, I direct that life-sustaining procedures be withheld and withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to keep me comfortable and to relieve pain.  The procedures and treatment to be withheld and withdrawn include, without limitation, surgery, antibiotics, cardiac and pulmonary resuscitation, respiratory support, blood and blood products, dialysis, chemotherapy, radiation therapy, and invasive diagnostic tests.  

INITIAL ONE OF THE FOLLOWING STATEMENTS

If my condition is terminal and could result in my death within a reasonably short time, 

_____ I direct that nutrition and hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

OR

_____ I direct that nutrition and hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

INITIAL ONE OF THE FOLLOWING STATEMENTS

If I am in a persistent vegetative state or other condition of permanent unconsciousness, 

_____ I direct that nutrition and hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

OR

_____ I direct that nutrition and hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

		If, upon my death, any of my tissue or organs would be of value for transplantation, I freely give my permission to the donation of such tissue or organs for such purpose.  

		In the absence of my ability to give directions regarding the use of life-sustaining procedures, it is my intention that this declaration shall be honored by my family, physicians, health care facilities and all concerned with my care as the final expression of my legal right to refuse medical or surgical treatment including without limitation the administration of life-sustaining procedures.  I accept the consequences of such refusal.  

		I understand the full import and meaning of this declaration, and I am aware that this declaration authorizes a physician to withhold and withdraw life-sustaining procedures.  I am at least eighteen years of age and I am emotionally and mentally competent to make this declaration.  

NOTE:  You may give another person authority to revoke this declaration on your behalf.  If you wish to do so, enter the person's name, address and telephone number in the space below:   

NOTE:  You may give another person authority to enforce this declaration on your behalf.  If you wish to do so, enter the person's name, address and telephone number in the space below:  

I appoint ________________________, presently residing at ____________________________, or if he/she is unable, unwilling or unavailable to act, then ______________________________, or if he/she is unable, unwilling or unavailable to act, then _________________________, as my agent.  

REVOCATION PROCEDURES

		THIS DECLARATION MAY BE REVOKED BY ANY ONE OF THE FOLLOWING METHODS (HOWEVER, A REVOCATION IS NOT EFFECTIVE UNTIL IT IS COMMUNICATED TO THE ATTENDING PHYSICIAN):

(1)  BY BEING DEFACED, TORN, OBLITERATED, OR OTHERWISE DESTROYED, IN EXPRESSION OF THE DECLARANT'S INTENT TO REVOKE, BY THE DECLARANT OR BY SOME PERSON IN THE PRESENCE OF AND BY THE DIRECTION OF THE DECLARANT.  REVOCATION BY DESTRUCTION OF ONE OR MORE OF MULTIPLE ORIGINAL DECLARATIONS REVOKES ALL OF THE ORIGINAL DECLARATIONS.  

(2)  BY A WRITTEN REVOCATION SIGNED AND DATED BY THE DECLARANT EXPRESSING HIS INTENT TO REVOKE THIS DECLARATION.  

(3)  BY AN ORAL EXPRESSION BY THE DECLARANT OF HIS INTENT TO REVOKE THIS DECLARATION.  HOWEVER, AN ORAL REVOCATION MADE BY THE DECLARANT BECOMES EFFECTIVE UPON COMMUNICATION TO THE ATTENDING PHYSICIAN BY A PERSON OTHER THAN THE DECLARANT ONLY IF:  (A) THE PERSON WAS PRESENT WHEN THE ORAL REVOCATION WAS MADE; (B) THE REVOCATION WAS COMMUNICATED TO THE PHYSICIAN WITHIN A REASONABLE TIME; AND (C) THE PHYSICAL OR MENTAL CONDITION OF THE DECLARANT MAKES IT IMPOSSIBLE FOR THE PHYSICIAN TO CONFIRM THROUGH SUBSEQUENT CONVERSATION WITH THE DECLARANT THAT THE REVOCATION HAS OCCURRED.  THE ORAL EXPRESSION CLEARLY MUST INDICATE A DESIRE THAT THIS DECLARATION NOT BE GIVEN EFFECT OR THAT LIFE-SUSTAINING PROCEDURES BE ADMINISTERED.

(4)  IF THE DECLARANT, IN THE SPACE ABOVE, HAS AUTHORIZED AN AGENT TO REVOKE THIS DECLARATION, THE AGENT MAY REVOKE ORALLY OR BY A WRITTEN, SIGNED, AND DATED INSTRUMENT.  AN AGENT MAY REVOKE THIS DECLARATION ONLY IF THE DECLARANT IS INCOMPETENT TO DO SO.  AN AGENT MAY REVOKE THIS DECLARATION PERMANENTLY OR TEMPORARILY.  

(5)  BY EXECUTING ANOTHER DECLARATION AT A LATER TIME.

		IN WITNESS WHEREOF, I have executed this declaration, as my free and voluntary act and deed, this _______ day of _______________, 2018. 

						 SIGNATURE OF PRINCIPAL:  

______________________________

STATE OF SOUTH CAROLINA

COUNTY OF _________________                    

		We, ______________________________________________ (Witness No.1) and ___________________________________________ (Witness No.1), as witnesses to the foregoing instrument, at least one of us being first being duly sworn before the undersigned authority, on the basis of our best information and belief, say that:  (1) the foregoing instrument on _______ day of __________________, 2018, was personally signed by the above principal in my presence, and thereupon I, at his request and in his presence and in the presence of the other witnesses, have hereunto subscribed my name as a witness; (2) I did not sign the above signature of the above principal for or at his/her direction; (3) I personally know the Principal and believe him to be of sound mind and under no constraint, duress, fraud or undue influence; (4) I am not related to the Principal by blood, marriage or adoption, either as a spouse, lineal ancestor, descendant of the parents of the Principal, or spouse of any of them; (5) I am not entitled (to the best of my knowledge and belief) to any portion of the estate of the Principal upon his death under any will or codicil of the Principal or by operation of law; (6) I do not have any present or inchoate claim against any portion of the estate of the Principal; nor am I the beneficiary of a life insurance policy of the Principal; (7) I do not have any financial responsibility for the medical care of the Principal; (8) I am not a physician or an employee of any physician, and I am not an operator or employee of, or patient in, any hospital, health care provider, residential care facility, community care facility, skilled nursing facility or similar institution; and (9) I and the Principal are both at least 18 years of age.

Dated: ___________________, 2018. 

__________________________
     Witness No.1
residing at: 	____________________________________

__________________________
     Witness No.2
residing at: 	____________________________________ 

STATE OF SOUTH CAROLINA

COUNTY OF BEAUFORT

		Subscribed, sworn to and acknowledged before me by the declarant, and subscribed and sworn to before me by the said __________________________ (Witness No.1 or No.2) as one of the said witnesses, this ________________ day of ________________, 2018.   

_______________________________
Notary Public for South Carolina
My commission expires on: ________

INFORMATION ABOUT THE ATTACHED

HEALTH CARE POWER OF ATTORNEY

WARNING TO PERSON EXECUTING THIS DOCUMENT -- 

THIS IS AN IMPORTANT LEGAL DOCUMENT.  BEFORE EXECUTING THIS DOCUMENT YOU SHOULD KNOW THESE IMPORTANT FACTS:

EXCEPT AS YOU OTHERWISE SPECIFY IN THIS DOCUMENT, THIS DOCUMENT GIVES THE PERSON YOU DESIGNATE AS YOUR AGENT (THE ATTORNEY-IN-FACT) THE POWER TO MAKE HEALTH CARE DECISIONS FOR YOU WHEN YOU ARE NO LONGER CAPABLE OF MAKING HEALTH CARE DECISIONS FOR YOURSELF.  THIS POWER INCLUDES THE POWER TO MAKE DECISIONS ABOUT LIFE-SUSTAINING TREATMENT.  UNLESS YOU STATE OTHERWISE, YOUR AGENT WILL HAVE THE SAME AUTHORITY TO MAKE DECISIONS ABOUT YOUR HEALTH CARE AS YOU WOULD HAVE.  

THIS POWER IS SUBJECT TO ANY LIMITATIONS OR STATEMENTS OF YOUR DESIRES THAT YOU INCLUDE IN THIS DOCUMENT.  YOU MAY STATE IN THIS DOCUMENT ANY TYPES OF TREATMENT OR PLACEMENTS YOU DO OR DO NOT DESIRE.  YOUR AGENT MUST ACT CONSISTENTLY WITH YOUR DESIRES AS STATED IN THIS DOCUMENT OR OTHERWISE MADE KNOWN.  

NOTWITHSTANDING THIS DOCUMENT, YOU HAVE THE RIGHT TO MAKE MEDICAL AND OTHER HEALTH CARE DECISIONS FOR YOURSELF SO LONG AS YOU CAN GIVE INFORMED CONSENT WITH RESPECT TO THE PARTICULAR DECISION.  NO TREATMENT MAY BE GIVEN TO YOU OVER YOUR OBJECTION AT THE TIME, AND HEALTH CARE NECESSARY TO KEEP YOU ALIVE MAY NOT BE STOPPED OR WITHHELD IF YOU OBJECT AT THE TIME.  

THIS DOCUMENT GIVES YOUR AGENT AUTHORITY TO CONSENT, TO REFUSE TO CONSENT, OR TO WITHDRAW CONSENT TO ANY CARE, TREATMENT, SERVICE, OR PROCEDURE TO MAINTAIN, DIAGNOSE, OR TREAT A PHYSICAL OR MENTAL CONDITION.  THIS POWER IS SUBJECT TO ANY STATEMENT OF YOUR DESIRES AND ANY LIMITATIONS THAT YOU INCLUDE IN THIS DOCUMENT.  YOU MAY SPECIFY IN THIS DOCUMENT ANY TYPES OF TREATMENT THAT YOU DO OR DO NOT DESIRE.  

YOU HAVE THE RIGHT TO REVOKE THE AUTHORITY OF YOUR AGENT OR TO REVOKE THIS DOCUMENT ENTIRELY BY NOTIFYING YOUR AGENT OR YOUR ATTENDING PHYSICIAN, HOSPITAL OR OTHER HEALTH CARE PROVIDER ORALLY OR IN WRITING OF THE REVOCATION.  

THIS DOCUMENT REVOKES ANY PRIOR DURABLE POWER OF ATTORNEY FOR HEALTH CARE, UNLESS YOU INDICATE OTHERWISE IN THIS DOCUMENT.  

WHEN ACTING PURSUANT TO THIS DOCUMENT, YOUR AGENT HAS THE RIGHT TO EXAMINE YOUR MEDICAL AND HEALTH CARE RECORDS AND TO CONSENT TO THEIR DISCLOSURE, UNLESS YOU LIMIT THIS RIGHT IN THIS DOCUMENT.

UNLESS YOU OTHERWISE SPECIFY IN THIS DOCUMENT, THIS DOCUMENT GIVES YOUR AGENT THE POWER AFTER YOU DIE TO DONATE YOUR BODY OR PARTS THEREOF FOR TRANSPLANT AND TO DIRECT THE DISPOSITION OF YOUR REMAINS.

IT IS IMPORTANT THAT YOU UNDERSTAND THE NATURE AND RANGE OF DECISIONS THAT MAY BE MADE ON YOUR BEHALF.  IF THERE IS ANYTHING IN THIS DOCUMENT THAT YOU DO NOT UNDERSTAND, YOU SHOULD ASK YOUR ATTORNEY OR PHYSICIAN TO EXPLAIN IT TO YOU.  YOU SHOULD DISCUSS THIS DOCUMENT WITH YOUR AGENT.  

YOUR AGENT MAY NEED THIS DOCUMENT IMMEDIATELY IN CASE OF AN EMERGENCY THAT REQUIRES A DECISION CONCERNING YOUR HEALTH CARE.  EITHER KEEP THIS DOCUMENT WHERE IT IS IMMEDIATELY AVAILABLE TO YOUR AGENT AND ALTERNATE AGENT OR GIVE EACH OF THEM AN EXECUTED COPY OF THIS DOCUMENT.  YOU ALSO MAY WANT TO GIVE YOUR PHYSICIAN AN EXECUTED COPY OF THIS DOCUMENT.

HEALTH CARE POWER OF ATTORNEY

TO:  My family, physicians and all those concerned with my care

	(1) DESIGNATION OF HEALTH CARE AGENT:  I, _________________________ (the “Principal”) in and presently residing at _________________________________________, and being at least eighteen years of age and of sound mind, hereby appoint and authorize _____________________________, presently residing at ______________________________, as my agent and attorney-in-fact to act for me and in my name to make and communicate health care decisions for me as authorized in this document; 

For purposes of this document, "health care decision" shall mean consent, refusal of consent, or withdrawal of consent to any care, treatment, service or procedure to maintain, diagnose or treat any medical or physical condition.  

		(2) EFFECTIVENESS OF APPOINTMENT:  By this document I intend to create a durable power of attorney for health care effective upon, and only during, any period of mental incompetence.  The authority of my agent and attorney-in-fact shall not terminate if I become disabled, incompetent or incapacitated.  

		(3) GENERAL STATEMENT OF AUTHORITY GRANTED:  Subject to any limitations in this document, in the event I at any time do not have the capacity to make informed health care decisions for myself, I hereby grant to my agent full power and authority to make health care decisions for me to the same extent that I could make such decisions for myself if I had the capacity to do so.  In exercising this authority, my agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to my agent, including without limitation my desires concerning obtaining or refusing or withdrawing life-sustaining care, treatment, services and procedures.  

		(4) STATEMENT OF DESIRES, SPECIAL PROVISIONS AND LIMITATIONS:  In exercising the authority under this durable power of attorney for health care, my agent shall act consistently with my desires as stated below and is subject to any special provisions and limitations stated below:  

		If at any time I should have a condition certified to be a terminal condition by two physicians who have personally examined me, one of whom shall be my attending physician, and the physicians have determined that my death could occur within a reasonably short period of time without the use of life-sustaining treatment or if the physicians certify that I am in a state of permanent unconsciousness, and where the application of life-sustaining treatment would serve only to prolong the dying process, I direct that life-sustaining treatment be withheld and withdrawn and that I be permitted to die naturally with only the administration of medication or the performance of any medical procedure deemed necessary to keep me comfortable and to relieve pain.  The procedures and treatment to be withheld and withdrawn include, without limitation, surgery, antibiotics, cardiac and pulmonary resuscitation, respiratory support, blood and blood products, dialysis, chemotherapy, radiation therapy, and invasive diagnostic tests.  

INITIAL ONE OF THE FOLLOWING STATEMENTS

If my condition is terminal and could result in my death within a reasonably short time, 

_____ I direct that nutrition and hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

OR

_____ I direct that nutrition and hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

INITIAL ONE OF THE FOLLOWING STATEMENTS

If I am in a persistent vegetative state or other condition of permanent unconsciousness, 

_____ I direct that nutrition and hydration NOT BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

OR

_____ I direct that nutrition and hydration BE PROVIDED through any medically indicated means, including medically or surgically implanted tubes. 

		I further delegate to my agent and attorney-in-fact the power and authority to select, employ and discharge health care personnel, such as physicians, nurses, therapists, hospice care and home health care providers, and other medical professionals; to admit or discharge me (including transfer from another facility) from any hospital, hospice, nursing home, adult home or other medical care facility; to apply for public benefits to defray the cost of health care; and to contract in my name and on my behalf for all health care services, including without limitation medical, nursing and hospital care, as my agent and attorney-in-fact may deem appropriate.  I confirm that I shall be and remain personally liable for the payment of all such care and services to the same extent as if I had personally contracted therefor.  

		I authorize my agent and attorney-in-fact to donate all or any part of my body for transplantation, or to otherwise direct the disposition of my remains.  

		(5) INSPECTION AND DISCLOSURE OF INFORMATION:  I grant to my agent the authority and power to serve as my personal representative for all purposes of the Health Insurance Portability and Accountability Act of 1996, the regulations in 45 C.F.R. Sec. 160 et seq., and any other applicable federal, state or local laws or regulations (collectively "HIPAA"), including the authority to request, receive, obtain and review, and be granted full and unlimited access to, and consent to the disclosure of complete unredacted copies of any and all health, medical and financial information and any information or records referred to in 45 C.F.R. Sec. 164.501 and regulated by the Standards for Privacy of Individually Identifiable Health Information found in 65 Fed. Reg. 82462 as protected private records or otherwise covered under HIPAA.  I understand that health and medical records can include information relating to subjects such as sexually transmitted diseases, acquired immunodeficiency syndrome (AIDS), AIDS-related complex (ARC) and human immunodeficiency virus (HIV), behavioral or mental health services, and treatment for alcohol or drug abuse or addiction.  I understand that I may have access to or receive an accounting of the information to be used or disclosed as provided in 45 C.F.R. Sec. 164.524 et seq.  I further understand that authorizing the disclosure of this health information is voluntary and that I can refuse to sign this authorization.  I further understand that any disclosure of this information carries with it the potential for an unauthorized further disclosure of this information by third parties and that such further disclosure may not be protected under HIPAA.  In order to induce the disclosing party to disclose the aforesaid private and/or protected confidential information, I forever release and hold harmless said disclosing party who relies upon this instrument from any liability under confidentiality rules arising under HIPAA as a consequence of said disclosure.  I authorize my agent to execute any and all releases or other documents that may be necessary in order to obtain disclosure of my patient records and other medical information subject to and protected by HIPAA.  

		(6) SIGNING DOCUMENTS, WAIVERS AND RELEASES:  I authorize my agent and attorney-in-fact to execute on my behalf any documents necessary or desirable to implement the health care decisions that my agent and attorney-in-fact is authorized to make pursuant to this document, including without limitation all documents pertaining to a refusal to permit medical treatment, or authorizing the leaving of a medical facility against medical advice, or any waivers or releases from liability required by a physician or health care provider.  

		(7) DURATION:  Unless I specify a shorter period below, this power of attorney shall exist until this document is revoked.  This power of attorney shall expire on:  

[Note:  Fill in an expiration date ONLY IF you want the authority of your agent to end on a specific date.]

		If I am unable to make health care decisions for myself when this power of attorney expires (on the date I may have inserted above), the authority I have granted to my agent and attorney-in-fact continues to exist until the time I become able to make health care decisions for myself.  

		(8) DESIGNATION OF ALTERNATE AGENTS:  If the person designated as my agent in paragraph (1) is not available or becomes ineligible to act as my agent to make a health care decision for me or loses the mental capacity to make health care decisions for me, or if I revoke that person's appointment or authority to make health care decisions for me, then I designate and appoint ____________________________, or if he/she is not available or becomes ineligible to act as my agent, then _____________________________, to serve as my agent to make health care decisions for me as authorized in this document.  

		(9) MISCELLANEOUS:  I revoke any prior durable power of attorney for health care.  

		The authority of my agent and attorney-in-fact shall become effective when I can no longer make my own medical decisions.  The determination of whether I can make my own medical decisions is to be made by the person serving as my agent and attorney-in-fact.  I have read the foregoing notice concerning the legal consequences of my executing this document.  I have discussed my wishes with, and have carefully selected, my agent and attorney-in-fact.  

		This document is intended to be valid in any jurisdiction in which it is presented.

		I understand that if I have a valid Declaration of a Desire for a Natural Death (a living will), the instructions contained in the Declaration will be given effect in any situation to which they are applicable.  It is my desire that my agent and attorney-in-fact will have authority to make decisions concerning my health care in situations to which the Declaration does not apply.

		If any provision of this document is held to be invalid or unenforceable, the remainder of this document shall continue in full force and effect.  

		IN WITNESS WHEREOF, I, ______________________________ (as Principal), sign this instrument this ______ day of _____________________, 2018, and hereby do declare to the undersigned witnesses that I execute it willingly, as my free and voluntary act and deed for the purposes therein expressed, and that I am eighteen years of age or older, of sound mind, and under no constraint, duress, fraud or undue influence.  

						 SIGNATURE OF PRINCIPAL: 

______________________________

WITNESS:

		We, ___________________________ and _____________________________, the witnesses whose names are signed to the foregoing instrument, at least one of us being first being duly sworn before the undersigned authority, on the basis of our best information and belief, say that:  (1) the foregoing instrument on this _____ day of ________________, 2018, was personally signed by the Principal in my presence, and thereupon I, at his request and in his presence and in the presence of the other witnesses, have hereunto subscribed my name as a witness; (2) I did not sign the above signature of the Principal for or at his direction; (3) I personally know the Principal and believe him to be of sound mind and under no constraint, duress, fraud or undue influence; (4) I am not related to the Principal by blood, marriage or adoption, either as a spouse, lineal ancestor, descendant of the parents of the Principal, or spouse of any of them; (5) I am not entitled (to the best of my knowledge and belief) to any portion of the estate of the Principal upon his death under any will or codicil of the Principal or by operation of law; (6) I do not have any present or inchoate claim against any portion of the estate of the Principal; nor am I the beneficiary of a life insurance policy of the Principal; (7) I do not have any financial responsibility for the medical care of the Principal; (8) I am not a physician or an employee of any physician, and I am not an operator or employee of, or patient in, any hospital, health care provider, residential care facility, community care facility, skilled nursing facility or similar institution; (9) I am not a person named as agent in this instrument; and (10) I and the Principal are both at least 18 years of age.

Dated:  ______________, 2018.

__________________________
     Witness No.1
residing at: 	____________________________________

 
__________________________
     Witness No.2
residing at: 	____________________________________ 

STATE OF SOUTH CAROLINA
COUNTY OF BEAUFORT COUNTY
		Sworn to and signed by __________________________________, the principal, and by ______________________________ (Witness No.1 or No.2) as one of the said witnesses, on this 8th day of July, 2017.  

_________________________________
Notary Public for South Carolina
My commission expires onJ: __________