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Hospital Visitation Authorization

October 6, 2011

If you are in a Domestic Partnership or Civil Union, think about executing a Hospital visitation Authorization, especially if the relationship with your partner’s extended family is not always pleasant.  This could avoid conflicts if your loved one is ever hospitalized, and decisions regarding treatment and other issues arise. You can prepare this document separately and keep it with your Advance Medical Directive. The necessary language is the following:

I, CLIENT NAME, now of Town, State, being of sound mind, willfully and voluntarily give notice and authorization that if I should be injured or fall ill or be incapacitated through any other cause that necessitates my hospitalization or treatment in a medical facility, it is my wish that my domestic partner/civil union partner, AGENT NAME, now of Town, State, be given first preference in being admitted to visit me in such medical or treatment facility, and that he be given final determination as to all others who wish to visit me in such medical or treatment facility, whether or not there are parties related to me by blood or by law or other parties desiring to visit me, unless and until I freely give contrary instructions to competent medical personnel on the premises involved.

IN WITNESS WHEREOF, I have on this ____ day of Month, 2011, executed this my Hospital Visitation Authorization. I sign my name to this document and being duly sworn, I do hereby declare to the undersigned authority that I sign and execute this instrument as my Hospital Visitation Authorization and that I sign it willingly (or willingly direct another to sign for me), that I execute it as my free and voluntary act for the purposes herein expressed and that I am eighteen (18) years of age or older, of sound mind, and under no constraint or undue influence.

CLIENT NAME, Declarant

If you would like to speak to a lawyer concerning this, and other legal issues affecting those in a domestic Partnership or Civil Union, please call my office for a free consultation.

Diana L. Anderson, Esquire

Carluccio, Leone, Dimon, Doyle & Sacks, Equality Company of the Year, Garden State Equality

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