[Can be used in a health care power of attorney, a living will, or a designation of agent form.] In the event of my incapacity, my Agent, _____________________________, shall be afforded the first opportunity to visit with my attending physician and me. If I am unable to express my own desires regarding visitation or discuss my care with my attending physician, my Agent shall have the sole right to decide when and if other parties may visit with my attending physician or me. My Agent shall have the authority to limit subsequent contact by third parties and relatives with my attending physician and myself. This provision is intended to clearly establish my Agent’s authority over my blood relatives or legal representatives who may hold priority over visitation, health care decisions, and conference with treating physicians, in the event of my incapacity, under applicable law or custom.
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