CRES minister emeritus
The Reverend Vern Barnet, DMn
AT MY DEATH
|Team of Friends to Handle My Affairs at My Death|
|End of Life Medical Directive|
|Durable Medical Decisions Power of Attorney|
|Memorial Service Plan|
(8 lines free)
Please do not expand.
This best presents the richness of my spare life.
man, teacher, and interfaith activist, died Xxx xx, in Kansas City. His son, Ben, survives him.
A memorial service is set for
XXX, xx, at xx pm, Grace and
Holy Trinity Cathedral.
If a photo is allowed, please use this one from my KC Star column--
DURABLE MEDICAL DECISIONS
KNOW ALL MEN BY THESE PRESENTS, that I, VERN BARNET, a resident of Kansas City, Jackson County, Missouri, desire to execute this DURABLE MEDICAL DECISIONS POWER OF ATTORNEY. In the event that any time I am unable to give directions regarding my medical care, then I appoint my dear friend, David E. Nelson, of 5735 N. Clinton Lane, Kansas City, Missouri 64119 (816.896.3 835) to make binding decisions concerning my medical treatment and in that connection and for that purpose I hereby appoint said individual as my Attomey-in-Fact, to make such decisions and to sign and deliver any and all documents deemed by my said Attorney-in-Fact to be in my best interest for the purposes of carrying out the wishes expressed in this Declaration. I have provided that David E. Nelson may consult with Kathy Riegelman, who is currently a chaplain at KU Medical Center in making any decisions. I hereby revoke any prior Durable Medical Decisions Powers of Attorney that I may have previously signed. This appointment constitutes a Durable Power of Attorney and shall no’t be affected by my disability or incapacity.
My Attorney-In-Fact is appointed to make any and all arrangements deemed appropriate and in my best interests for my personal care, support, maintenance, living arrangements and medical care, including admission to a retirement home or facility, extended care facility, nursing home, or similar facility; additionally, the authorizations and authority granted in this paragraph shall specifically include the power to direct providers of health care to limit or withhold life support measures of the kind sometimes referred to as "heroic" or extraordinary" where it is determined by my said Attorney-in-Fact, after consulting with medical advisors, that there is no reasonable possibility that I can thereafter regain any meaningful existence; and in such event I hereby exonerate all parties involved in such actions (or decisions not to act) from any or all liability, civil or criminal, as a result thereof, and I direct that my estate shall hold all such parties harmless and indemnify each and all of them from any such liability.
(a) I hereby ratify and confirm all lawful acts done and caused to be done by my said Attorney-in-Fact pursuant to this Durable Medical Decisions Power of Attorney, and I direct that it shall continue in effect until the termination date herein specified unless sooner terminated by me or by operation of law. To the full extent permitted by law, my subsequent mental incapacity shall not operate as a revocation of this Durable Medical Decisions Power of Attorney;
(b) If the authority contained herein shall be revoked or terminated by operation of law without notice, I hereby agree for myself, executors, administrators, heirs and assigns, in consideration of my Attomey’s willingness to act pursuant to this Power of Attorney, to save and hold my Attorney harmless from any loss suffered or any liability incurred by my Attorney in so acting after such revocation or termination without notice;
(c) Through this instrument, the masculine gender shall be deemed to include the feminine or neuter, and the singular the plural, and vice versa.
(d) I intend for my attomey in fact to be treated as I would be with respect to my rights regarding the use and disclosure of my individually identifiable health information or other medical records. This release authority applies to any information governed by the Health Insurance Portability and Accountability Act of 1996 (I—HPAA), 42 USC l320d and 45 CFR 160-164.
(e) I authorize any physician, healthcare professional, dentist, health plan, hospital, clinic, laboratory, pharmacy or other covered health care provider, any insurance company and the Medical Information Bureau, Inc., or other health care clearinghouse that has provided treatment or services to me or that has paid for or is seeking payment from me for such services to give, disclose and release to my agent, without restrictions, all of my individually identifiable health information and medical records regarding any past, present of future medical or mental health condition, including but not limited to information relating to the diagnosis and treatment of HIV/AIDS, sexually transmitted diseases, mental illness and drug and alcohol abuse.
IN WITNESS WHEREOF, I have hereunto set my hand and seal this 21st day of January, 2020.
STATE OF KANSAS )
I, the undersigned, a Notary Public in and for the County and State aforesaid, do hereby certify that on the 21st day of January, 2020, before me, personally appeared VERN BARNET, who is known by me to be the person who is described in, whose name is subscribed to, and who signed and executed the foregoing instrument, and having first made known to me that he signed and sealed the same on the date it bears as his true, free and voluntary act and deed for the uses, purposes and considerations therein set forth.
IN WITNESS WHEREOF, I have hereunto set my hand and affixed m official seal this day and year above.
Maureen DraskovichMy Commission Expires:
Notary Public, State of Kansas
My Appointment Expires
ACCEPTANCE OF AUTHORITY AND AGREEMENT TO ACT
Now on this 21st day of January, 2020, David E. Nelson, attorney in fact, accepts the authority granted in this document and agrees to act in the best interest of the above named principal in carrying out the duties and responsibilities set forth in this document until such time as said authority is terminated by the principal or by operation of law, whichever occurs first.
David E. Nelson
State of Kansas )
This instrument was acknowledged before me on this
21st day of
BEN COMPTONMy Appointment Expires 11/16/2022