Lasting Power Of Attorney For Health And Welfare

A Lasting Power of Attorney is to protect your interests during your lifetime and is the only way to ensure that the people you trust are in a position to deal with your property, financial affairs and health & welfare where you are unable to do so, for example, due to a serious accident or an illness that affects your mental capacity, like dementia.

There are two types of Lasting Powers of Attorney:

Health and welfare Lasting Power of Attorney: this gives your attorney power to make decision such as medical care, accommodation, daily routine and giving or refusing consent to life-sustaining treatments.

Property and financial affairs Lasting Power of Attorney: this gives your attorney power to manage bank accounts, deal with benefits, savings and investments, pensions, pay bills or buy and/or sell property.

You can only make an Lasting Power of Attorney when you have the mental capacity to do so. We can guide you through the process to help you prepare a Lasting Power of Attorney that reflects your wishes.

Please fill out our online form below. If you need assistance or have any questions, please contact us.

Lasting Power of Attorney for Health and Welfare

Section 1 – The Donor

Prefix

First Name *

Middle Name

Last Name

Any other names you're known by

Date of birth *

Month

Day

Year

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address

Section 2 – The Attorneys

Your attorneys will be the people you choose to make decisions on your behalf. They should be people that you know and trust well. You need at least one attorney, but you can have more.

Prefix

First Name *

Middle Name

Last Name

Any other names you're known by

Date of birth *

Month

Day

Year

Street Address *

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

Email Address

Add another attorneyYes

Section 3 – How should your attorneys make decisions?

You need to choose whether your attorneys can make decisions on their own or must agree some or all decisions unanimously. Whatever you choose, they must always act in your best interests.

I only appointed one attorneyYesNo

Section 4 – Replacement Attorneys

This section is optional, but we recommend you consider it.

Replacement attorneys are a backup in case one of your original attorneys can’t make decisions for you any more. To appoint a trust corporation, fill in the first attorney space below and tick the box in that section. Reasons replacement attorneys step in – if one of your original attorneys dies, loses capacity, no longer wants to be your attorney, becomes bankrupt or subject to a debt relief order or is no longer legally your husband, wife or civil partner.

Restrictions – replacement attorneys must be at least 18 years old and have mental capacity to make decisions. They must not be bankrupt or subject to a debt relief order.

Prefix

First Name

Middle Name

Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

This attorney is a trust corporationYesNo

Another replacementYes

Section 5 – Life-sustaining treatment

This is an important part of your LPA.You must choose whether your attorneys can give or refuse consent to life-sustaining treatment on your behalf. Life-sustaining treatment means care, surgery, medicine or other help from doctors that’s needed to keep you alive, for example:

• a serious operation, such as a heart bypass or organ transplant
• cancer treatment
• artificial nutrition or hydration (food or water given other than by mouth)

Whether some treatments are life-sustaining depends on the situation. If you had pneumonia, a simple course of antibiotics could be life-sustaining. Decisions about life-sustaining treatment can be needed in unexpected circumstances, such as a routine operation that didn’t go as planned.

Who do you want to make decisions about life-sustaining treatment? (sign only one option)Option A – I give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf. If you choose this option, your attorneys can speak to doctors on your behalf as if they were you.Option B – I do not give my attorneys authority to give or refuse consent to life-sustaining treatment on my behalf. If you choose this option, your doctors will take into account the views of the attorneys and of people who are interested in your welfare as well as any written statement you may have made, where it is practical and appropriate.

Section 6 – When can your attorneys make decisions?

When can your attorneys make decisions?As soon as my LPA has been registered (and also when I don’t have mental capacity). Most people choose this option because it is the most practical. While you still have mental capacity, your attorneys can only act with your consent. If you later lose capacity, they can continue to act on your behalf for all decisions covered by this LPA. This option is useful if you are able to make your own decisions but there’s another reason you want your attorneys to help you – for example, if you’re away on holiday, or if you have a physical condition that makes it difficult to visit the bank, talk on the phone or sign documents.Only when I don’t have mental capacity. Be careful – this can make your LPA a lot less useful. Your attorneys might be asked to prove you do not have mental capacity each time they try to use this LPA.

Section 7 – People to notify when the LPA is registered.

This section is optional

You can let people know that you’re going to register your LPA. They can raise any concerns they have about the LPA – for example, if there was any pressure or fraud in making it. When the LPA is registered, the person applying to register (you or one of your attorneys) must send a notice to each ‘person to notify’.

You can’t put your attorneys or replacement attorneys here.

People to notify can object to the LPA, but only for certain reasons (listed in the notification form LP3). After that, they are no longer involved in the LPA. Choose people who care about your best interests and who would be willing to speak up if they were concerned.

Prefix

First Name

Middle Name

Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

I want to appoint another person to notify (maximum 5)Yes

Section 8 – Preferences and instructions

This section is optional. You can tell your attorneys how you’d prefer them to make decisions, or give them specific instructions which they must follow when making decisions.

Most people leave this page blank – you can just talk to your attorneys so they understand how you want them to make decisions for you.

Preferences

Your attorneys don’t have to follow your preferences but they should keep them in mind.

Preferences – use words like ‘prefer’ and ‘would like’

Section 9 – Certificate Provider

The certificate provider will discuss the lasting power of attorney with the donor to ensure that the donor understands what they are doing and that nobody is forcing them to do it.

The certificate provider should be either:

a) Someone who has known the donor personally for at least 2 years, such as a friend, neighbour, colleague, or former colleague; or
b) Someone with relevant professional skills, such as the donor’s GP, a healthcare professional or a solicitor.

Prefix

First Name

Middle Name

Last Name

Street Address

Apartment, suite, etc

City

State/Province

ZIP / Postal Code

Country

What Happens Next?

Following submission of your Lasting Power of Attorney for Health & Welfare questionnaire, a member of the DJS Law Solicitors’ team will contact you and shall provide you with our Letter of Engagement that will contain a quotation, together with our Terms of Business. A signed Letter of Engagement is required to be returned before we commence any work on your Lasting Power of Attorney.

Lasting Power Of Attorney For Health And Welfare

Lasting Power of Attorney for Health and Welfare

Section 1 – The Donor

Section 2 – The Attorneys

Section 3 – How should your attorneys make decisions?

Section 4 – Replacement Attorneys

Section 5 – Life-sustaining treatment

Section 6 – When can your attorneys make decisions?

Section 7 – People to notify when the LPA is registered.

Section 8 – Preferences and instructions

Section 9 – Certificate Provider

What Happens Next?

Services

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