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ADVANCE DIRECTIVE FOR HEALTHCARE
You have the right to give instructions about your own healthcare. You also have the right to name someone else to
make healthcare decisions for you. This form lets you do EITHER or BOTH of these things. It also lets you express
your wishes regarding the designation of your primary physician.
THIS FORM IS OPTIONAL. Each paragraph and word of this form is also optional. If you use this form, you
may cross out, complete or modify all or any part of it. You are free to use a different form. If you have already
signed a valid durable power of attorney for healthcare and/or right to die statement (living will), these statements
are still valid. If you use this form, be sure to sign it and date it.
YOU DO NOT HAVE TO SIGN ANY FORM. If you do not sign a form or tell your doctor whom you want to
make your healthcare decisions (or if someone you identify is not reasonably available), New Mexico law allows a
family member who is reasonably available, to make your healthcare decisions. Family members are selected in the
following order: 1) spouse, 2) significant other, 3) adult child, 4) parent, 5) adult brother or sister, 6) grandparent.
If no family member is available, a close friend may act as a surrogate.
PART 1: POWER OF ATTORNEY FOR HEALTHCARE
Part 1 of this form is a power of attorney for healthcare. It lets you name another individual as agent to make
healthcare decisions for you if you become incapable of making your own decisions, or if you want someone
else to make those decisions for you now, even though you are still capable. You may also name alternate
agents to act for you if your first choice is not willing, able, or reasonably available to make decisions for you.
Unless related to you, your agent may not be an owner, operator or employee of a healthcare institution at
which you are receiving care.
This form has a place for you to limit the authority of your agent. If you do not limit your agent's authority,
your agent may