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1    AN ACT concerning civil law.
 
2    Be it enacted by the People of the State of Illinois,
3represented in the General Assembly:
 
4    Section 5. The Illinois Power of Attorney Act is amended by
5changing Sections 4-5.1 and 4-10 as follows:
 
6    (755 ILCS 45/4-5.1)
7    Sec. 4-5.1. Limitations on who may witness health care
8agencies.
9    (a) Every health care agency shall bear the signature of a
10witness to the signing of the agency. No witness may be under
1118 years of age. None of the following licensed professionals
12providing services to the principal may serve as a witness to
13the signing of a health care agency:
14        (1) the attending physician, advanced practice nurse,
15    physician assistant, dentist, podiatric physician,
16    optometrist, or psychologist mental health service
17    provider of the principal, or a relative of the physician,
18    advanced practice nurse, physician assistant, dentist,
19    podiatric physician, optometrist, or psychologist mental
20    health service provider;
21        (2) an owner, operator, or relative of an owner or
22    operator of a health care facility in which the principal
23    is a patient or resident;

 

 

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1        (3) a parent, sibling, or descendant, or the spouse of
2    a parent, sibling, or descendant, of either the principal
3    or any agent or successor agent, regardless of whether the
4    relationship is by blood, marriage, or adoption;
5        (4) an agent or successor agent for health care.
6    (b) The prohibition on the operator of a health care
7facility from serving as a witness shall extend to directors
8and executive officers of an operator that is a corporate
9entity but not other employees of the operator such as, but not
10limited to, non-owner chaplains or social workers, nurses, and
11other employees.
12(Source: P.A. 98-1113, eff. 1-1-15.)
 
13    (755 ILCS 45/4-10)  (from Ch. 110 1/2, par. 804-10)
14    Sec. 4-10. Statutory short form power of attorney for
15health care.
16    (a) The form prescribed in this Section (sometimes also
17referred to in this Act as the "statutory health care power")
18may be used to grant an agent powers with respect to the
19principal's own health care; but the statutory health care
20power is not intended to be exclusive nor to cover delegation
21of a parent's power to control the health care of a minor
22child, and no provision of this Article shall be construed to
23invalidate or bar use by the principal of any other or
24different form of power of attorney for health care.
25Nonstatutory health care powers must be executed by the

 

 

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1principal, designate the agent and the agent's powers, and
2comply with the limitations in Section 4-5 of this Article, but
3they need not be witnessed or conform in any other respect to
4the statutory health care power.
5    No specific format is required for the statutory health
6care power of attorney other than the notice must precede the
7form. The statutory health care power may be included in or
8combined with any other form of power of attorney governing
9property or other matters.
10    (b) The Illinois Statutory Short Form Power of Attorney for
11Health Care shall be substantially as follows:
 
12
NOTICE TO THE INDIVIDUAL SIGNING
13
THE POWER OF ATTORNEY FOR HEALTH CARE
14    No one can predict when a serious illness or accident might
15occur. When it does, you may need someone else to speak or make
16health care decisions for you. If you plan now, you can
17increase the chances that the medical treatment you get will be
18the treatment you want.
19    In Illinois, you can choose someone to be your "health care
20agent". Your agent is the person you trust to make health care
21decisions for you if you are unable or do not want to make them
22yourself. These decisions should be based on your personal
23values and wishes.
24    It is important to put your choice of agent in writing. The
25written form is often called an "advance directive". You may

 

 

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1use this form or another form, as long as it meets the legal
2requirements of Illinois. There are many written and on-line
3resources to guide you and your loved ones in having a
4conversation about these issues. You may find it helpful to
5look at these resources while thinking about and discussing
6your advance directive.
 
7
WHAT ARE THE THINGS I WANT MY
8
HEALTH CARE AGENT TO KNOW?
9    The selection of your agent should be considered carefully,
10as your agent will have the ultimate decision making authority
11once this document goes into effect, in most instances after
12you are no longer able to make your own decisions. While the
13goal is for your agent to make decisions in keeping with your
14preferences and in the majority of circumstances that is what
15happens, please know that the law does allow your agent to make
16decisions to direct or refuse health care interventions or
17withdraw treatment. Your agent will need to think about
18conversations you have had, your personality, and how you
19handled important health care issues in the past. Therefore, it
20is important to talk with your agent and your family about such
21things as:
22        (i) What is most important to you in your life?
23        (ii) How important is it to you to avoid pain and
24    suffering?
25        (iii) If you had to choose, is it more important to you

 

 

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1    to live as long as possible, or to avoid prolonged
2    suffering or disability?
3        (iv) Would you rather be at home or in a hospital for
4    the last days or weeks of your life?
5        (v) Do you have religious, spiritual, or cultural
6    beliefs that you want your agent and others to consider?
7        (vi) Do you wish to make a significant contribution to
8    medical science after your death through organ or whole
9    body donation?
10        (vii) Do you have an existing advanced directive, such
11    as a living will, that contains your specific wishes about
12    health care that is only delaying your death? If you have
13    another advance directive, make sure to discuss with your
14    agent the directive and the treatment decisions contained
15    within that outline your preferences. Make sure that your
16    agent agrees to honor the wishes expressed in your advance
17    directive.
 
18
WHAT KIND OF DECISIONS CAN MY AGENT MAKE?
19    If there is ever a period of time when your physician
20determines that you cannot make your own health care decisions,
21or if you do not want to make your own decisions, some of the
22decisions your agent could make are to:
23        (i) talk with physicians and other health care
24    providers about your condition.
25        (ii) see medical records and approve who else can see

 

 

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1    them.
2        (iii) give permission for medical tests, medicines,
3    surgery, or other treatments.
4        (iv) choose where you receive care and which physicians
5    and others provide it.
6        (v) decide to accept, withdraw, or decline treatments
7    designed to keep you alive if you are near death or not
8    likely to recover. You may choose to include guidelines
9    and/or restrictions to your agent's authority.
10        (vi) agree or decline to donate your organs or your
11    whole body if you have not already made this decision
12    yourself. This could include donation for transplant,
13    research, and/or education. You should let your agent know
14    whether you are registered as a donor in the First Person
15    Consent registry maintained by the Illinois Secretary of
16    State or whether you have agreed to donate your whole body
17    for medical research and/or education.
18        (vii) decide what to do with your remains after you
19    have died, if you have not already made plans.
20        (viii) talk with your other loved ones to help come to
21    a decision (but your designated agent will have the final
22    say over your other loved ones).
23    Your agent is not automatically responsible for your health
24care expenses.
 
25
WHOM SHOULD I CHOOSE TO BE MY HEALTH CARE AGENT?

 

 

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1    You can pick a family member, but you do not have to. Your
2agent will have the responsibility to make medical treatment
3decisions, even if other people close to you might urge a
4different decision. The selection of your agent should be done
5carefully, as he or she will have ultimate decision-making
6authority for your treatment decisions once you are no longer
7able to voice your preferences. Choose a family member, friend,
8or other person who:
9        (i) is at least 18 years old;
10        (ii) knows you well;
11        (iii) you trust to do what is best for you and is
12    willing to carry out your wishes, even if he or she may not
13    agree with your wishes;
14        (iv) would be comfortable talking with and questioning
15    your physicians and other health care providers;
16        (v) would not be too upset to carry out your wishes if
17    you became very sick; and
18        (vi) can be there for you when you need it and is
19    willing to accept this important role.
 
20
WHAT IF MY AGENT IS NOT AVAILABLE OR IS
21
UNWILLING TO MAKE DECISIONS FOR ME?
22    If the person who is your first choice is unable to carry
23out this role, then the second agent you chose will make the
24decisions; if your second agent is not available, then the
25third agent you chose will make the decisions. The second and

 

 

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1third agents are called your successor agents and they function
2as back-up agents to your first choice agent and may act only
3one at a time and in the order you list them.
 
4
WHAT WILL HAPPEN IF I DO NOT
5
CHOOSE A HEALTH CARE AGENT?
6    If you become unable to make your own health care decisions
7and have not named an agent in writing, your physician and
8other health care providers will ask a family member, friend,
9or guardian to make decisions for you. In Illinois, a law
10directs which of these individuals will be consulted. In that
11law, each of these individuals is called a "surrogate".
12    There are reasons why you may want to name an agent rather
13than rely on a surrogate:
14        (i) The person or people listed by this law may not be
15    who you would want to make decisions for you.
16        (ii) Some family members or friends might not be able
17    or willing to make decisions as you would want them to.
18        (iii) Family members and friends may disagree with one
19    another about the best decisions.
20        (iv) Under some circumstances, a surrogate may not be
21    able to make the same kinds of decisions that an agent can
22    make.
 
23
WHAT IF THERE IS NO ONE AVAILABLE
24
WHOM I TRUST TO BE MY AGENT?

 

 

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1    In this situation, it is especially important to talk to
2your physician and other health care providers and create
3written guidance about what you want or do not want, in case
4you are ever critically ill and cannot express your own wishes.
5You can complete a living will. You can also write your wishes
6down and/or discuss them with your physician or other health
7care provider and ask him or her to write it down in your
8chart. You might also want to use written or on-line resources
9to guide you through this process.
 
10
WHAT DO I DO WITH THIS FORM ONCE I COMPLETE IT?
11    Follow these instructions after you have completed the
12form:
13        (i) Sign the form in front of a witness. See the form
14    for a list of who can and cannot witness it.
15        (ii) Ask the witness to sign it, too.
16        (iii) There is no need to have the form notarized.
17        (iv) Give a copy to your agent and to each of your
18    successor agents.
19        (v) Give another copy to your physician.
20        (vi) Take a copy with you when you go to the hospital.
21        (vii) Show it to your family and friends and others who
22    care for you.
 
23
WHAT IF I CHANGE MY MIND?
24    You may change your mind at any time. If you do, tell

 

 

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1someone who is at least 18 years old that you have changed your
2mind, and/or destroy your document and any copies. If you wish,
3fill out a new form and make sure everyone you gave the old
4form to has a copy of the new one, including, but not limited
5to, your agents and your physicians.
 
6
WHAT IF I DO NOT WANT TO USE THIS FORM?
7    In the event you do not want to use the Illinois statutory
8form provided here, any document you complete must be executed
9by you, designate an agent who is over 18 years of age and not
10prohibited from serving as your agent, and state the agent's
11powers, but it need not be witnessed or conform in any other
12respect to the statutory health care power.
13    If you have questions about the use of any form, you may
14want to consult your physician, other health care provider,
15and/or an attorney.
 
16
MY POWER OF ATTORNEY FOR HEALTH CARE

 
17THIS POWER OF ATTORNEY REVOKES ALL PREVIOUS POWERS OF ATTORNEY
18FOR HEALTH CARE. (You must sign this form and a witness must
19also sign it before it is valid)
 
20My name (Print your full name):..........
21My address:..................................................
 

 

 

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1I WANT THE FOLLOWING PERSON TO BE MY HEALTH CARE AGENT
2(an agent is your personal representative under state and
3federal law):
4(Agent name).................
5(Agent address).............
6(Agent phone number).........................................
 
7(Please check box if applicable) .... If a guardian of my
8person is to be appointed, I nominate the agent acting under
9this power of attorney as guardian.
 
10SUCCESSOR HEALTH CARE AGENT(S) (optional):
11    If the agent I selected is unable or does not want to make
12health care decisions for me, then I request the person(s) I
13name below to be my successor health care agent(s). Only one
14person at a time can serve as my agent (add another page if you
15want to add more successor agent names):
16.............................................................
17(Successor agent #1 name, address and phone number)
18.............................................................
19(Successor agent #2 name, address and phone number)
 
20MY AGENT CAN MAKE HEALTH CARE DECISIONS FOR ME, INCLUDING:
21        (i) Deciding to accept, withdraw or decline treatment
22    for any physical or mental condition of mine, including
23    life-and-death decisions.

 

 

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1        (ii) Agreeing to admit me to or discharge me from any
2    hospital, home, or other institution, including a mental
3    health facility.
4        (iii) Having complete access to my medical and mental
5    health records, and sharing them with others as needed,
6    including after I die.
7        (iv) Carrying out the plans I have already made, or, if
8    I have not done so, making decisions about my body or
9    remains, including organ, tissue or whole body donation,
10    autopsy, cremation, and burial.
11    The above grant of power is intended to be as broad as
12possible so that my agent will have the authority to make any
13decision I could make to obtain or terminate any type of health
14care, including withdrawal of nutrition and hydration and other
15life-sustaining measures.
 
16I AUTHORIZE MY AGENT TO (please check any one box):
17    .... Make decisions for me only when I cannot make them for
18    myself. The physician(s) taking care of me will determine
19    when I lack this ability.
20        (If no box is checked, then the box above shall be
21    implemented.) OR
22    .... Make decisions for me only when I cannot make them for
23    myself. The physician(s) taking care of me will determine
24    when I lack this ability. Starting now, my agent shall have
25    complete access to my medical and mental health records,

 

 

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1    the authority to share them with others as needed, and the
2    complete ability to communicate with my personal
3    physician(s) and other health care providers, including
4    the ability to require an opinion of my physician as to
5    whether I lack the ability to make decisions for myself. OR
6    .... Make decisions for me starting now and continuing
7    after I am no longer able to make them for myself. While I
8    am still able to make my own decisions, I can still do so
9    if I want to, but want my agent to be consulted, if
10    available.
 
11    The subject of life-sustaining treatment is of particular
12importance. Life-sustaining treatments may include tube
13feedings or fluids through a tube, breathing machines, and CPR.
14In general, in making decisions concerning life-sustaining
15treatment, your agent is instructed to consider the relief of
16suffering, the quality as well as the possible extension of
17your life, and your previously expressed wishes. Your agent
18will weigh the burdens versus benefits of proposed treatments
19in making decisions on your behalf.
20    Additional statements concerning the withholding or
21removal of life-sustaining treatment are described below.
22These can serve as a guide for your agent when making decisions
23for you. Ask your physician or health care provider if you have
24any questions about these statements.
 

 

 

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1SELECT ONLY ONE STATEMENT BELOW THAT BEST EXPRESSES YOUR WISHES
2(optional):
3    .... The quality of my life is more important than the
4    length of my life. If I am unconscious and my attending
5    physician believes, in accordance with reasonable medical
6    standards, that I will not wake up or recover my ability to
7    think, communicate with my family and friends, and
8    experience my surroundings, I do not want treatments to
9    prolong my life or delay my death, but I do want treatment
10    or care to make me comfortable and to relieve me of pain.
11    .... Staying alive is more important to me, no matter how
12    sick I am, how much I am suffering, the cost of the
13    procedures, or how unlikely my chances for recovery are. I
14    want my life to be prolonged to the greatest extent
15    possible in accordance with reasonable medical standards.
 
16SPECIFIC LIMITATIONS TO MY AGENT'S DECISION-MAKING AUTHORITY:
17    The above grant of power is intended to be as broad as
18possible so that your agent will have the authority to make any
19decision you could make to obtain or terminate any type of
20health care. If you wish to limit the scope of your agent's
21powers or prescribe special rules or limit the power to
22authorize autopsy or dispose of remains, you may do so
23specifically in this form.
24..................................
25..............................
 

 

 

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1My signature:..................
2Today's date:................................................
 
3HAVE YOUR WITNESS AGREE TO WHAT IS WRITTEN BELOW, AND THEN
4COMPLETE THE SIGNATURE PORTION:
5    I am at least 18 years old. (check one of the options
6below):
7    .... I saw the principal sign this document, or
8    .... the principal told me that the signature or mark on
9    the principal signature line is his or hers.
10    I am not the agent or successor agent(s) named in this
11document. I am not related to the principal, the agent, or the
12successor agent(s) by blood, marriage, or adoption. I am not
13the principal's physician, advanced practice nurse, dentist,
14podiatric physician, optometrist, psychologist mental health
15service provider, or a relative of one of those individuals. I
16am not an owner or operator (or the relative of an owner or
17operator) of the health care facility where the principal is a
18patient or resident.
19Witness printed name:............
20Witness address:..............
21Witness signature:...............
22Today's date:................................................
 
23SUCCESSOR HEALTH CARE AGENT(S) (optional):

 

 

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1    If the agent I selected is unable or does not want to make
2health care decisions for me, then I request the person(s) I
3name below to be my successor health care agent(s). Only one
4person at a time can serve as my agent (add another page if you
5want to add more successor agent names):
6.............................................................
7(Successor agent #1 name, address and phone number)
8.............................................................
9(Successor agent #2 name, address and phone number)
 
10    (c) The statutory short form power of attorney for health
11care (the "statutory health care power") authorizes the agent
12to make any and all health care decisions on behalf of the
13principal which the principal could make if present and under
14no disability, subject to any limitations on the granted powers
15that appear on the face of the form, to be exercised in such
16manner as the agent deems consistent with the intent and
17desires of the principal. The agent will be under no duty to
18exercise granted powers or to assume control of or
19responsibility for the principal's health care; but when
20granted powers are exercised, the agent will be required to use
21due care to act for the benefit of the principal in accordance
22with the terms of the statutory health care power and will be
23liable for negligent exercise. The agent may act in person or
24through others reasonably employed by the agent for that
25purpose but may not delegate authority to make health care

 

 

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1decisions. The agent may sign and deliver all instruments,
2negotiate and enter into all agreements and do all other acts
3reasonably necessary to implement the exercise of the powers
4granted to the agent. Without limiting the generality of the
5foregoing, the statutory health care power shall include the
6following powers, subject to any limitations appearing on the
7face of the form:
8        (1) The agent is authorized to give consent to and
9    authorize or refuse, or to withhold or withdraw consent to,
10    any and all types of medical care, treatment or procedures
11    relating to the physical or mental health of the principal,
12    including any medication program, surgical procedures,
13    life-sustaining treatment or provision of food and fluids
14    for the principal.
15        (2) The agent is authorized to admit the principal to
16    or discharge the principal from any and all types of
17    hospitals, institutions, homes, residential or nursing
18    facilities, treatment centers and other health care
19    institutions providing personal care or treatment for any
20    type of physical or mental condition. The agent shall have
21    the same right to visit the principal in the hospital or
22    other institution as is granted to a spouse or adult child
23    of the principal, any rule of the institution to the
24    contrary notwithstanding.
25        (3) The agent is authorized to contract for any and all
26    types of health care services and facilities in the name of

 

 

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1    and on behalf of the principal and to bind the principal to
2    pay for all such services and facilities, and to have and
3    exercise those powers over the principal's property as are
4    authorized under the statutory property power, to the
5    extent the agent deems necessary to pay health care costs;
6    and the agent shall not be personally liable for any
7    services or care contracted for on behalf of the principal.
8        (4) At the principal's expense and subject to
9    reasonable rules of the health care provider to prevent
10    disruption of the principal's health care, the agent shall
11    have the same right the principal has to examine and copy
12    and consent to disclosure of all the principal's medical
13    records that the agent deems relevant to the exercise of
14    the agent's powers, whether the records relate to mental
15    health or any other medical condition and whether they are
16    in the possession of or maintained by any physician,
17    psychiatrist, psychologist, therapist, hospital, nursing
18    home or other health care provider. The authority under
19    this paragraph (4) applies to any information governed by
20    the Health Insurance Portability and Accountability Act of
21    1996 ("HIPAA") and regulations thereunder. The agent
22    serves as the principal's personal representative, as that
23    term is defined under HIPAA and regulations thereunder.
24        (5) The agent is authorized: to direct that an autopsy
25    be made pursuant to Section 2 of "An Act in relation to
26    autopsy of dead bodies", approved August 13, 1965,

 

 

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1    including all amendments; to make a disposition of any part
2    or all of the principal's body pursuant to the Illinois
3    Anatomical Gift Act, as now or hereafter amended; and to
4    direct the disposition of the principal's remains.
5        (6) At any time during which there is no executor or
6    administrator appointed for the principal's estate, the
7    agent is authorized to continue to pursue an application or
8    appeal for government benefits if those benefits were
9    applied for during the life of the principal.
10    (d) A physician may determine that the principal is unable
11to make health care decisions for himself or herself only if
12the principal lacks decisional capacity, as that term is
13defined in Section 10 of the Health Care Surrogate Act.
14    (e) If the principal names the agent as a guardian on the
15statutory short form, and if a court decides that the
16appointment of a guardian will serve the principal's best
17interests and welfare, the court shall appoint the agent to
18serve without bond or security. If appointed hereunder, the
19court appointed guardian shall be the legal health care
20decision maker for the principal.
21(Source: P.A. 97-148, eff. 7-14-11; 98-1113, eff. 1-1-15.)
 
22    Section 99. Effective date. This Act takes effect January
231, 2016.