**ALABAMA HEALTH CARE POWER OF ATTORNEY

(Advance Directive for Health Care)**

[// GUIDANCE: This template is designed to comply with Alabama Code Title 22, Chapter 8A (Alabama Advance Directive for Health Care Act) and the federal HIPAA Privacy Rule, 45 C.F.R. Parts 160 & 164. Customize bracketed items, delete inapplicable options, and review all provisions for client-specific suitability before execution.]

TABLE OF CONTENTS

1. Document Header
2. Definitions
3. Operative Provisions
   3.1 Appointment of Health Care Agent
   3.2 Scope of Authority
   3.3 End-of-Life Decisions
   3.4 HIPAA Authorization & Medical Information
   3.5 Nomination of Guardian (Optional)
   3.6 Reliance & Revocation
4. Representations & Warranties
5. Covenants & Restrictions
6. Default & Remedies
7. Risk Allocation
8. Dispute Resolution
9. General Provisions
10. Execution Block

1. DOCUMENT HEADER

1.1 Title. Health Care Power of Attorney (the “Instrument”).

1.2 Parties.
(a) Principal: [PRINCIPAL NAME], residing at [ADDRESS] (“Principal”).
(b) Agent: [AGENT NAME], residing at [ADDRESS] (“Agent”).

1.3 Effective Date. This Instrument is effective upon the date of Principal’s signature below (the “Effective Date”) and remains in effect until revoked pursuant to Section 3.6.

1.4 Governing Law. This Instrument is governed by the Alabama Advance Directive for Health Care Act, Ala. Code § 22-8A-1 et seq., and other applicable Alabama law (“State Health-Care Law”).

2. DEFINITIONS

“Advance Directive” means this Instrument together with any written health-care instructions executed by Principal.

“Alternate Agent” means the individual(s) named in Section 3.1(b) authorized to act if the primary Agent is unable or unwilling to serve.

“End-of-Life Decision” means any decision regarding life-sustaining treatment, artificial nutrition or hydration, or other measures addressed in Section 3.3.

“Good Faith” has the meaning set forth in Ala. Code § 22-8A-10(d); actions taken honestly, without malice, and in accordance with this Instrument.

“Health-Care Provider” means any individual or entity licensed, certified, or otherwise authorized to administer health-care services in Alabama.

“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations at 45 C.F.R. Parts 160 & 164.

“Principal’s Incapacity” means the determination, made in writing by the attending physician, that Principal lacks sufficient understanding or capacity to communicate health-care decisions.

[// GUIDANCE: Add additional definitions as needed for specialized circumstances.]

3. OPERATIVE PROVISIONS

3.1 Appointment of Health Care Agent

(a) Principal hereby appoints [AGENT NAME] as Agent to make any and all health-care decisions on Principal’s behalf whenever Principal is unable to make or communicate such decisions.
(b) Alternate Agents. If the Agent is unable, unwilling, or unavailable to act, the following persons shall serve successively as Alternate Agent:
1. First Alternate Agent: [FIRST ALTERNATE NAME]
2. Second Alternate Agent: [SECOND ALTERNATE NAME]

[// GUIDANCE: Alabama permits only one person to serve as primary decision-maker at a time. List alternates in order of priority.]

3.2 Scope of Authority

Agent may, subject to any limitations expressly stated herein:
1. Provide consent for, withdraw, or refuse any care, treatment, service, or procedure;
2. Admit or discharge Principal from hospitals, nursing homes, or other facilities;
3. Contract on Principal’s behalf for any health-care related service or device;
4. Access, review, and copy Principal’s medical records;
5. Authorize autopsy and organ or tissue donation consistent with applicable law; and
6. Take any lawful action necessary to implement decisions under this Instrument.

Limitations (if any): [INSERT “None” or specify limitations, e.g., “Agent shall not consent to electroconvulsive therapy.”]

3.3 End-of-Life Decisions

(a) Terminal Illness / Persistent Vegetative State. If Principal is diagnosed with a terminal condition or is in a persistent vegetative state and is unable to communicate:
☐ Principal does authorize Agent to withhold or withdraw life-sustaining treatment.
☐ Principal does not authorize Agent to withhold or withdraw life-sustaining treatment.

(b) Artificial Nutrition & Hydration.
☐ Agent may withhold/withdraw artificial nutrition and hydration.
☐ Agent must maintain artificial nutrition and hydration.

(c) Pain Relief. Agent may authorize any measure to alleviate pain, even if it may hasten death.

[// GUIDANCE: Check only one box in each subsection. Attach additional instruction pages if desired.]

3.4 HIPAA Authorization & Medical Information

(a) Full Release. Pursuant to 45 C.F.R. § 164.502(g), Principal authorizes any Health-Care Provider to disclose Protected Health Information (“PHI”) to Agent to the same extent as Principal could.
(b) Duration. This release remains effective for the duration of this Instrument and survives Principal’s death to the extent necessary to carry out decisions made under Section 3.2 or applicable law.
(c) Redisclosure. Agent may redisclose PHI as reasonably necessary to perform duties herein.

3.5 Nomination of Guardian (Optional)

Principal nominates Agent to serve as guardian or conservator of the person in any future guardianship proceeding.

3.6 Reliance & Revocation

(a) Any third party may rely on Agent’s representation of authority without further inquiry.
(b) Principal may revoke this Instrument at any time by:
1. A signed, written revocation;
2. An oral statement witnessed by two adults; or
3. Physical destruction of this Instrument with intent to revoke.

4. REPRESENTATIONS & WARRANTIES

4.1 Principal affirms:
(a) Capacity to execute this Instrument;
(b) Execution is voluntary and without duress;
(c) All prior health-care powers of attorney are either revoked or compatible.

4.2 Agent represents and warrants that Agent:
(a) Is not presently serving as Principal’s Health-Care Provider or employee thereof, unless a related family member permitted under Ala. Code § 22-8A-11(b);
(b) Accepts appointment and will act in Good Faith consistent with Principal’s wishes and best interests;
(c) Will keep reasonably contemporaneous records of material decisions made hereunder.

5. COVENANTS & RESTRICTIONS

5.1 Agent’s Affirmative Covenants. Agent shall:
(a) Consult with Health-Care Providers to ascertain treatment options;
(b) Follow any clear statement of Principal’s wishes;
(c) Provide copies of this Instrument to relevant Health-Care Providers promptly upon request.

5.2 Agent’s Negative Covenants. Agent shall not:
(a) Delegate decision-making authority except to an Alternate Agent expressly designated herein;
(b) Receive compensation beyond reasonable out-of-pocket expenses unless otherwise agreed in writing.

6. DEFAULT & REMEDIES

6.1 Events of Default. Any of the following constitutes default by Agent:
(a) Breach of the Good Faith standard;
(b) Failure or refusal to act when required;
(c) Acting outside the scope of authority granted herein.

6.2 Notice & Cure. Any interested person may give written notice of default to Agent; Agent has forty-eight (48) hours to cure if the nature of default permits.

6.3 Remedies. Upon uncured default, any interested party or Health-Care Provider may:
(a) Petition the appropriate Alabama probate court for removal of Agent and appointment of Alternate Agent or guardian;
(b) Seek injunctive relief enforcing, or preventing action contrary to, this Instrument.

7. RISK ALLOCATION

7.1 Indemnification. Principal agrees to indemnify and hold harmless Agent from any liability, loss, or expense, including reasonable attorneys’ fees, arising from actions taken in Good Faith pursuant to this Instrument.

7.2 Limitation of Liability. Neither Agent nor any Health-Care Provider relying in Good Faith on this Instrument shall be liable to Principal or Principal’s estate for actions or inactions consistent with its terms, except for willful misconduct or gross negligence.

7.3 Force Majeure. Agent’s nonperformance caused by an event beyond reasonable control (including natural disaster, war, or pandemic) shall not constitute breach.

8. DISPUTE RESOLUTION

8.1 Governing Law. This Instrument and all disputes arising hereunder are governed by Alabama law.

8.2 Forum Selection. Exclusive jurisdiction and venue lie in the probate court of the county in Alabama where Principal resides or is receiving treatment.

8.3 Jury Waiver / Arbitration. No jury-trial waiver or arbitration agreement is provided. The parties reserve all constitutional rights to trial by jury where applicable.

8.4 Injunctive Relief. Nothing herein limits any party’s right to seek emergency injunctive relief to enforce health-care directives or prevent irreparable harm.

9. GENERAL PROVISIONS

9.1 Amendment & Waiver. Principal may amend this Instrument only by a later-dated writing signed and witnessed in accordance with Alabama law. No waiver of any provision shall be effective unless in writing.

9.2 Assignment & Delegation. Authority granted herein is personal to Agent and may not be assigned or delegated except to an Alternate Agent expressly named.

9.3 Severability. If any provision is held invalid, the remainder shall be enforced to the fullest extent permitted by law, and the invalid provision shall be reformed to fulfill the original intent.

9.4 Integration. This Instrument constitutes the entire advance directive of Principal, superseding all prior inconsistent instruments.

9.5 Counterparts; Electronic Signatures. This Instrument may be executed in counterparts, each deemed an original. Signatures transmitted electronically or by facsimile shall be deemed valid and binding to the fullest extent permitted by law.

10. EXECUTION BLOCK

IN WITNESS WHEREOF, Principal has executed this Health Care Power of Attorney on the Effective Date set forth below.

STATEMENT OF AGENT

I accept the designation as Agent and agree to act in Good Faith pursuant to this Instrument.

WITNESS ATTESTATION

We declare that we are adults, not named as Agent or Alternate Agent, not directly involved in providing health-care to Principal, and not entitled to any portion of Principal’s estate. Principal appeared to execute this Instrument voluntarily and to be of sound mind.

[// GUIDANCE: Alabama law requires either two qualified witnesses OR a notary public. If notarizing instead, replace witness section with standard notary acknowledgment.]

[// GUIDANCE: Practitioners should deliver copies of the executed Instrument to the Agent, Alternate Agents, primary physician, and any health-care facility where the Principal receives treatment. Retain the original in a readily accessible location.]