The following was taken from a Discussion Group. Can’t say how important it is to take steps before a catastrophe may occur.
In this case, the conversation is in relationship to CPS, who may come knocking at your door.
Do feel free to pass this on to others. Actually, some of us are going door to door, and/or personally giving this information to those who are very concerned in protecting their family.
Also, another bit of information one may want to read is found on this page>> http;//nfpcar.org/Miranda .
Basically, “If you do not know your Rights, You have none."
Note: I am not a lawyer. Please seek appropriate Legal Council.
May you find strength in Your Higher Power,
GranPa Chuck
Keeper of the web files for http://nfpcar.org
Question on Medical Power of Attorney
I am much confused where medical POA is concerned. How does that fall into CPS being unable to take a child ? I have POA doc's on my Mom and my Son in case they cannot speak for their best interest where medical care is concerned. Can you explain how this works for children and CPS ?I would very much like to have my Son and his girl friend do this in case after the children go home CPS tries to step in again pulling the children before the case actually closes.
A Basic Answer
CPS claims to be protecting the child because there is no fit person to care for the kids as they feel the parents unfit. Now if theree is a designated alternative set up before the parents were claimed to be unfit, CPS can't take them away.
Template for Medical Power of Attorney
MEDICAL POWER OF ATTORNEY
DESIGNATION OF HEALTH CARE AGENT
FOR
_____________________________child's name
THE STATE OF _____________ )
) KNOW ALL MEN BY THESE PRESENTS
COUNTY OF _______________ )
I, ______________________, the mother of
______________________, being of sound mind, willfully and voluntarily
appoint my _____________________, and her
husband, _____________________ of
(address)_____________________________________, as my agents to make
any and all health care decisions for my minor _______________, (son/
daughter ) ____________________________(name) who was born on
________________
except
to the extent that I state otherwise in this document. This medical
power of attorney takes effect immediately and is given to make
provision for the care and treatment of my ____________(son/daughter ,
___________________________(name )., in the event that I am out of
town, am unable to be located or reached, or am unable to make health
care
decisions for him/ her (pick one)
LIMITATIONS ON THE DECISION MAKING AUTHORITY OF MY AGENT ARE AS FOLLOWS:
None.
The original of this document is kept with __________________________________
_______________________________________________________(name/address).
The following individuals or institutions have signed copies:
Name:
Address:
Home Phone:
Work Phone:
Name:
Address:
Home Phone:
Work Phone:
Name:
Address:
Phone:
Fax:
page 1************************************************************************
DURATION.
I understand that this power of attorney exists indefinitely from the date I execute this document
unless
I establish a shorter time or revoke this power of attorney. In am out
of town or unable to be reached or unable to make health care decisions
for my________ son/daughter, __________________(name) , when this power
of attorney expires, the authority I have granted my agent continues
until the time I return to town, become available or become able to
make health care decisions for my son/daughter
________________________(name)..
The authority 1 have granted my agent shall include, but not be limited to the following:.
1.To request, review, and receive any and all medical, hospital and related information and
records, and to execute a release or other document required to obtain such information;
2. To consent to the disclosure of medical and related information to others;
3. To employ and discharge medical and related personnel;
4. To consent, refuse consent, or withdraw consent to medical care, treatment, service or
procedure, subject to my directions expressed in an effective Directive to Physicians;
5. To provide appropriate relief from pain;
6. To arrange for care and lodging in a hospital or other medical facility;
7. To grant releases to health care professionals or institutions to assure that my wishes for my
___________(son/daughter) care are fulfilled;
8. To authorize anatomical gifts; and
9. To arrange to hire and to pay the salaries of employees, nurses and similar health care
providers, and to see that required tax returns are filed.
PRIOR DESIGNATIONS REVOKED.
I revoke any prior medical power of attorney for my ____________(son/daughter)_________________ (name)..
ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.
I
have been provided with a disclosure statement explaining the effect of
this document. I have read and understand that information contained in
the disclosure statement.
I
sign my name to this medical power of attorney for my
____________(son/daughter), ______________________(name). on
_________________(date) at __________(city), _____________ County,
_____________(state).
__________________________________
name of mother, mother of ________________
_____________ (name) address below
________________________________
_________________________________
page 2 ***************************************************************************************************************
STATEMENT AND SIGNATURE OF FIRST WITNESS.
I
am not the person appointed as agent by this document. I am not related
to either _______________________(mother) or her
_____________(son/daughter ), ___________________(name)., by blood or
marriage. I would not be entitled to
any
portion of the estate of ________________(mother) or
_______________________ (child)., on the death of
_______________________(child) .. I am not the attending physician of
___________________(mother) or __________________________(child)
or
an employee of the attending physician. I have no claim against any
portion of the estate of ____________________(mother)
________________(child) , on the death of __________________(child)..
Furthermore, if I am an employee of a health care facility in which
_______________________(child) . is a patient, I am not involved in
providing direct patient care to _______________________(child). and am
not an officer, director, partner, or business office employee ofthe
health care facility or of any parent organization ofthe health care
facility.
_______________________________(witness in front of notary)
name
address
date
ST ATEMENT AND SIGNATURE OF SECOND WITNESS.
I
am not the person appointed as agent by this document. I am not related
to either _______________________(mother) or her
_____________(son/daughter ), ___________________(name)., by blood or
marriage. I would not be entitled to
any
portion of the estate of ________________(mother) or
_______________________ (child)., on the death of
_______________________(child) .. I am not the attending physician of
___________________(mother) or __________________________(child)
or
an employee of the attending physician. I have no claim against any
portion of the estate of ____________________(mother)
________________(child) , on the death of __________________(child)..
Furthermore, if I am an employee of a health care facility in which
_______________________(child) . is a patient, I am not involved in
providing direct patient care to _______________________(child). and am
not an officer, director, partner, or business office employee ofthe
health care facility or of any parent organization ofthe health care
facility.
__________________________(name)
name printed
address
date
SUBSCRIBED
AND SWORN TO BEFORE ME by the said ___________________(mother),
Principal, and by the said ___________________(witness 1)
and________________(#2), Witnesses, __________________(date).
_______________________________
Notary Public, State of ______________
page 3*************************************************************************************************************************
INFORMATION CONCERNING THE
MEDICAL POWER OF ATTORNEY
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
YOU SHOULD KNOW THESE IMPORTANT FACTS:
Except
to the extent you state otherwise, this document gives the person you
name as your agent the authority to make any and all health care
decisions for your ________(son/daughter), ____________________(child's
name)., in accordance with your wishes when you are out of town or
unavailable or no longer capable of making them for your
_____________(son/daughter), including your religious and moral
beliefs, when you are no longer capable of making them yourself.
Because
"health care" means any treatment, service or procedure to maintain,
diagnose or treat your ___________(son/daughter) 's physical or mental
condition, your agent has the power to make a broad range of health
care decisions for your ____________(son/daughter). Your agent may
consent, refuse to consent or withdraw consent to medical treatment and
may make decisions about withdrawing or withholding life-sustaining
treatment. Your agent may not consent to voluntary inpatient mental
health services, convulsive treatment, psychosurgery or abortion . A
physician must comply with your agent's instructions or allow your
_____________(son/daughter) to be transferred to another physician.
Your
agent's authority begins immediately so that proper care and treatment
can be provided for your _________________(son/daughter) in the event
you are unavailable, are out of town or lack the competence to make
health care decisions for _______him/her.
Your
agent is obligated to follow your instructions when making decisions on
your __________________(son/daughter) 's behalf. Unless you state
otherwise, your agent has the same authority to make decisions about
your __________(son/daughter)'s health care as you would have had if
you had been personally present.
It
is important that you discuss this document with your
____________(son/daughter)'s physician or other health care provider
before you sign it to make sure that you understand the nature and
range of decisions that may be made on your behalf. If your
________________(son/daughter) does not have a physician , you should
talk with your physician or if you do not have a physician, with
someone else who is knowledgeable about these issues and can answer
your questions.
You
do not need a lawyer's assistance to complete this document, but if
there is anything in this document that you do not understand, you
should ask a lawyer to explain it to you.
The
person you appoint as agent for your _______________(son/daughter)
should be someone you know and trust. The person must be 18 years of
age or older or a person under 18 years of age who has had the
disabilities of minority removed . If you appoint your
__________________(son/daughter) 's health or residential care provider
(e.g., his physician or an employee of a home health agency, hospital,
nursing home, or residential care home, other than a relative), that
person has to choose between acting as your agent or as your
_________(son/daughter) 's health or residential care provider; the law
does not permit a person to do both at the same time.
You
should inform the person you appoint that you want the person to be
your ___________________(son/daughter)'s health care agent. You should
discuss this document with your agent and your
______________(son/daughter's physician and give each a signed copy.
You should indicate on the document itself the people and institutions
who have signed copies. Your agent is not liable for health care
decisions made in good faith on your ________________(son/daughter) 's
behalf.
Even
after you have signed this document, you have the right to make health
care decisions for your ___________(son/daughter) as long as you are
available, not out of town and are able to do so and treatment cannot
be given to your _____________(son/daughter) or stopped over your
objection. You have the right to revoke the authority granted to your
agent by informing your agent or your ______________(son/daughter) 's
health or residential care provider orally or in writing, or by your
execution of a subsequent medical power of attorney for your
__________(son/daughter). Unless you state otherwise, your appointment
of a spouse dissolves on divorce.
This document may not be changed or modified . If you want to make changes in the document, you must make an entirely new one.
You may wish to designate an alternate agent in the event that your agent is unwilling, unable or
ineligible
to act as your agent. Any alternate agent you designate has the same
authority to make health care decisions for your
_______________(son/daughter) .
THIS
POWER OF ATTORNEY IS NOT VALID UNLESS ITIS SIGNED IN THE PRESENCE OF
TWO COMPETENT ADULT WITNESSES . THE FOLLOWING PERSONS MAY NOT ACT AS
ONE OF THE WITNESSES:
(1) the person you have designated as your agent;
(2) a person related to you by blood or marriage;
(3) a person entitled to any part of your estate after your death under a will or codicil executed
by you or by operation of law;
(4) your attending physician;
(5) an employee of your attending physician;
(6) an employee of a health care facility in which you are a patient if the employee is providing
direct patient care to you or is an officer, director, partner, or business office employee of
the health care facility or of any parent organization of the health care facility; or
(7) a person who, at the time this power of attorney is executed, has a claim against any part of
your estate after your death.
I certify I have received a copy ofthis "Information Concerning the Medical Power of Attorney."
_____________________________
mothers name
date
page
4,5 space it how you think it looks
good*************************************************************************************
HIP AA RELEASE AUTHORITY
I,
______________________(mother), intend for any agent named in this
release to be treated as I would be treated with respect to my rights
regarding the use and disclosure of individually
identifiable
health information and other medical records for my
________(son/daughter). This release authority applies to any
information governed by the Health Insurance PortabIlIty and
Accountability Act of 1996 ("HIPAA"), 42 U.S.C. l320d and 45 C.F .R.
160-164.
I authorize the disclosure of any such information governed by HIP AA to be provided to the
following: ___________________(name of agent 1) and/or _______________(agent 2).
Accordingly, I hereby authorize any physician, health-care professional, dentist, health plan,
hospital,
clinic, laboratory, pharmacy or other covered health-care provider, any
insurance company and the Medical Information Bureau Inc. or other
health-care clearinghouse that has provided treatment or services to my
___________(son/daughter), or that has paid for or is seeking payment
from me for such services, to give, disclose and release to my agent,
or any alternate agent, who is named herein and who is currently
serving as such, without restriction, all of my
__________(son/daughter)'s individually identifiable health information
and medical records regarding any past, present or future medical or
mental health condition, including all information relating to the
diagnosis and treatment of HIV I AIDS, sexually transmitted diseases,
mental illness, and drug or alcohol abuse.
This authority given to my agent shall supersede any prior agreement that I may have made
with
my ___________(son/daughter)'s health-care providers to restrict access
to or disclosure of my __________(son/daughter)'s individually
identifiable health information. The individually identifiable health
information and other medical records given, disclosed, or released to
my agent may be subject to redisclosure by my agent and may no longer
be protected by HIP AA. The authority given to my agent herein has no
expiration date and shall expire only in the event that I revoke this
HIPAA Release in writing and deliver it to my
______________(son/daughter)'s heath-care provider. There are no
exceptions to my right to revoke this HIP AA Release.
___________________________________
name of mother , mother of ____________child
address
SUBSCRIBED AND SWORN TO BEFORE ME by the said __________________(mother),
Principal on this ___ th day .of ______________ month ________year.
________________________________
Notary Public State of _______________
DESIGNATION OF HEALTH CARE AGENT
FOR
_____________________________child's name
THE STATE OF _____________ )
) KNOW ALL MEN BY THESE PRESENTS
COUNTY OF _______________ )
I, ______________________, the mother of
______________________, being of sound mind, willfully and voluntarily
appoint my _____________________, and her
husband, _____________________ of
(address)_____________________________________, as my agents to make
any and all health care decisions for my minor _______________, (son/
daughter ) ____________________________(name) who was born on
________________
except
to the extent that I state otherwise in this document. This medical
power of attorney takes effect immediately and is given to make
provision for the care and treatment of my ____________(son/daughter ,
___________________________(name )., in the event that I am out of
town, am unable to be located or reached, or am unable to make health
care
decisions for him/ her (pick one)
LIMITATIONS ON THE DECISION MAKING AUTHORITY OF MY AGENT ARE AS FOLLOWS:
None.
The original of this document is kept with __________________________________
_______________________________________________________(name/address).
The following individuals or institutions have signed copies:
Name:
Address:
Home Phone:
Work Phone:
Name:
Address:
Home Phone:
Work Phone:
Name:
Address:
Phone:
Fax:
page 1************************************************************************
DURATION.
I understand that this power of attorney exists indefinitely from the date I execute this document
unless
I establish a shorter time or revoke this power of attorney. In am out
of town or unable to be reached or unable to make health care decisions
for my________ son/daughter, __________________(name) , when this power
of attorney expires, the authority I have granted my agent continues
until the time I return to town, become available or become able to
make health care decisions for my son/daughter
________________________(name)..
The authority 1 have granted my agent shall include, but not be limited to the following:.
1.To request, review, and receive any and all medical, hospital and related information and
records, and to execute a release or other document required to obtain such information;
2. To consent to the disclosure of medical and related information to others;
3. To employ and discharge medical and related personnel;
4. To consent, refuse consent, or withdraw consent to medical care, treatment, service or
procedure, subject to my directions expressed in an effective Directive to Physicians;
5. To provide appropriate relief from pain;
6. To arrange for care and lodging in a hospital or other medical facility;
7. To grant releases to health care professionals or institutions to assure that my wishes for my
___________(son/daughter) care are fulfilled;
8. To authorize anatomical gifts; and
9. To arrange to hire and to pay the salaries of employees, nurses and similar health care
providers, and to see that required tax returns are filed.
PRIOR DESIGNATIONS REVOKED.
I revoke any prior medical power of attorney for my ____________(son/daughter)_________________ (name)..
ACKNOWLEDGMENT OF DISCLOSURE STATEMENT.
I
have been provided with a disclosure statement explaining the effect of
this document. I have read and understand that information contained in
the disclosure statement.
I
sign my name to this medical power of attorney for my
____________(son/daughter), ______________________(name). on
_________________(date) at __________(city), _____________ County,
_____________(state).
__________________________________
name of mother, mother of ________________
_____________ (name) address below
________________________________
_________________________________
page 2 ***************************************************************************************************************
STATEMENT AND SIGNATURE OF FIRST WITNESS.
I
am not the person appointed as agent by this document. I am not related
to either _______________________(mother) or her
_____________(son/daughter ), ___________________(name)., by blood or
marriage. I would not be entitled to
any
portion of the estate of ________________(mother) or
_______________________ (child)., on the death of
_______________________(child) .. I am not the attending physician of
___________________(mother) or __________________________(child)
or
an employee of the attending physician. I have no claim against any
portion of the estate of ____________________(mother)
________________(child) , on the death of __________________(child)..
Furthermore, if I am an employee of a health care facility in which
_______________________(child) . is a patient, I am not involved in
providing direct patient care to _______________________(child). and am
not an officer, director, partner, or business office employee ofthe
health care facility or of any parent organization ofthe health care
facility.
_______________________________(witness in front of notary)
name
address
date
ST ATEMENT AND SIGNATURE OF SECOND WITNESS.
I
am not the person appointed as agent by this document. I am not related
to either _______________________(mother) or her
_____________(son/daughter ), ___________________(name)., by blood or
marriage. I would not be entitled to
any
portion of the estate of ________________(mother) or
_______________________ (child)., on the death of
_______________________(child) .. I am not the attending physician of
___________________(mother) or __________________________(child)
or
an employee of the attending physician. I have no claim against any
portion of the estate of ____________________(mother)
________________(child) , on the death of __________________(child)..
Furthermore, if I am an employee of a health care facility in which
_______________________(child) . is a patient, I am not involved in
providing direct patient care to _______________________(child). and am
not an officer, director, partner, or business office employee ofthe
health care facility or of any parent organization ofthe health care
facility.
__________________________(name)
name printed
address
date
SUBSCRIBED
AND SWORN TO BEFORE ME by the said ___________________(mother),
Principal, and by the said ___________________(witness 1)
and________________(#2), Witnesses, __________________(date).
_______________________________
Notary Public, State of ______________
page 3*************************************************************************************************************************
INFORMATION CONCERNING THE
MEDICAL POWER OF ATTORNEY
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT,
YOU SHOULD KNOW THESE IMPORTANT FACTS:
Except
to the extent you state otherwise, this document gives the person you
name as your agent the authority to make any and all health care
decisions for your ________(son/daughter), ____________________(child's
name)., in accordance with your wishes when you are out of town or
unavailable or no longer capable of making them for your
_____________(son/daughter), including your religious and moral
beliefs, when you are no longer capable of making them yourself.
Because
"health care" means any treatment, service or procedure to maintain,
diagnose or treat your ___________(son/daughter) 's physical or mental
condition, your agent has the power to make a broad range of health
care decisions for your ____________(son/daughter). Your agent may
consent, refuse to consent or withdraw consent to medical treatment and
may make decisions about withdrawing or withholding life-sustaining
treatment. Your agent may not consent to voluntary inpatient mental
health services, convulsive treatment, psychosurgery or abortion . A
physician must comply with your agent's instructions or allow your
_____________(son/daughter) to be transferred to another physician.
Your
agent's authority begins immediately so that proper care and treatment
can be provided for your _________________(son/daughter) in the event
you are unavailable, are out of town or lack the competence to make
health care decisions for _______him/her.
Your
agent is obligated to follow your instructions when making decisions on
your __________________(son/daughter) 's behalf. Unless you state
otherwise, your agent has the same authority to make decisions about
your __________(son/daughter)'s health care as you would have had if
you had been personally present.
It
is important that you discuss this document with your
____________(son/daughter)'s physician or other health care provider
before you sign it to make sure that you understand the nature and
range of decisions that may be made on your behalf. If your
________________(son/daughter) does not have a physician , you should
talk with your physician or if you do not have a physician, with
someone else who is knowledgeable about these issues and can answer
your questions.
You
do not need a lawyer's assistance to complete this document, but if
there is anything in this document that you do not understand, you
should ask a lawyer to explain it to you.
The
person you appoint as agent for your _______________(son/daughter)
should be someone you know and trust. The person must be 18 years of
age or older or a person under 18 years of age who has had the
disabilities of minority removed . If you appoint your
__________________(son/daughter) 's health or residential care provider
(e.g., his physician or an employee of a home health agency, hospital,
nursing home, or residential care home, other than a relative), that
person has to choose between acting as your agent or as your
_________(son/daughter) 's health or residential care provider; the law
does not permit a person to do both at the same time.
You
should inform the person you appoint that you want the person to be
your ___________________(son/daughter)'s health care agent. You should
discuss this document with your agent and your
______________(son/daughter's physician and give each a signed copy.
You should indicate on the document itself the people and institutions
who have signed copies. Your agent is not liable for health care
decisions made in good faith on your ________________(son/daughter) 's
behalf.
Even
after you have signed this document, you have the right to make health
care decisions for your ___________(son/daughter) as long as you are
available, not out of town and are able to do so and treatment cannot
be given to your _____________(son/daughter) or stopped over your
objection. You have the right to revoke the authority granted to your
agent by informing your agent or your ______________(son/daughter) 's
health or residential care provider orally or in writing, or by your
execution of a subsequent medical power of attorney for your
__________(son/daughter). Unless you state otherwise, your appointment
of a spouse dissolves on divorce.
This document may not be changed or modified . If you want to make changes in the document, you must make an entirely new one.
You may wish to designate an alternate agent in the event that your agent is unwilling, unable or
ineligible
to act as your agent. Any alternate agent you designate has the same
authority to make health care decisions for your
_______________(son/daughter) .
THIS
POWER OF ATTORNEY IS NOT VALID UNLESS ITIS SIGNED IN THE PRESENCE OF
TWO COMPETENT ADULT WITNESSES . THE FOLLOWING PERSONS MAY NOT ACT AS
ONE OF THE WITNESSES:
(1) the person you have designated as your agent;
(2) a person related to you by blood or marriage;
(3) a person entitled to any part of your estate after your death under a will or codicil executed
by you or by operation of law;
(4) your attending physician;
(5) an employee of your attending physician;
(6) an employee of a health care facility in which you are a patient if the employee is providing
direct patient care to you or is an officer, director, partner, or business office employee of
the health care facility or of any parent organization of the health care facility; or
(7) a person who, at the time this power of attorney is executed, has a claim against any part of
your estate after your death.
I certify I have received a copy ofthis "Information Concerning the Medical Power of Attorney."
_____________________________
mothers name
date
page
4,5 space it how you think it looks
good*************************************************************************************
HIP AA RELEASE AUTHORITY
I,
______________________(mother), intend for any agent named in this
release to be treated as I would be treated with respect to my rights
regarding the use and disclosure of individually
identifiable
health information and other medical records for my
________(son/daughter). This release authority applies to any
information governed by the Health Insurance PortabIlIty and
Accountability Act of 1996 ("HIPAA"), 42 U.S.C. l320d and 45 C.F .R.
160-164.
I authorize the disclosure of any such information governed by HIP AA to be provided to the
following: ___________________(name of agent 1) and/or _______________(agent 2).
Accordingly, I hereby authorize any physician, health-care professional, dentist, health plan,
hospital,
clinic, laboratory, pharmacy or other covered health-care provider, any
insurance company and the Medical Information Bureau Inc. or other
health-care clearinghouse that has provided treatment or services to my
___________(son/daughter), or that has paid for or is seeking payment
from me for such services, to give, disclose and release to my agent,
or any alternate agent, who is named herein and who is currently
serving as such, without restriction, all of my
__________(son/daughter)'s individually identifiable health information
and medical records regarding any past, present or future medical or
mental health condition, including all information relating to the
diagnosis and treatment of HIV I AIDS, sexually transmitted diseases,
mental illness, and drug or alcohol abuse.
This authority given to my agent shall supersede any prior agreement that I may have made
with
my ___________(son/daughter)'s health-care providers to restrict access
to or disclosure of my __________(son/daughter)'s individually
identifiable health information. The individually identifiable health
information and other medical records given, disclosed, or released to
my agent may be subject to redisclosure by my agent and may no longer
be protected by HIP AA. The authority given to my agent herein has no
expiration date and shall expire only in the event that I revoke this
HIPAA Release in writing and deliver it to my
______________(son/daughter)'s heath-care provider. There are no
exceptions to my right to revoke this HIP AA Release.
___________________________________
name of mother , mother of ____________child
address
SUBSCRIBED AND SWORN TO BEFORE ME by the said __________________(mother),
Principal on this ___ th day .of ______________ month ________year.
________________________________
Notary Public State of _______________
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