Connecticut General Statutes Title 1. Provisions of General Application § 1-350h. When power of attorney effective

(a) A power of attorney is effective when executed unless the principal provides in the power of attorney that it becomes effective at a future date or upon the occurrence of a future event or contingency.

(b) If a power of attorney becomes effective upon the occurrence of a future event or contingency, the principal, in the power of attorney, may authorize one or more persons to determine in a writing or other record that the event or contingency has occurred.

(c) If a power of attorney becomes effective upon the principal's incapacity and the principal has not authorized a person to determine whether the principal is incapacitated, or the person authorized is unable or unwilling to make the determination, the power of attorney becomes effective upon a determination in a writing or other record by:

(d) A person authorized by the principal in the power of attorney to determine that the principal is incapacitated may act as the principal's personal representative pursuant to the Health Insurance Portability and Accountability Act,  1 Sections 1171 to 1179, inclusive, of the Social Security Act, 42 USC 1320d, as amended from time to time, and applicable federal regulations, to obtain access to the principal's health care information and communicate with the principal's health care provider.

(e) If the principal, in the power of attorney, authorizes one or more persons to determine in a written affidavit that the event or contingency has occurred, as provided in subsection (b) of this section, then the written affidavit may be in substantially the following form:

AFFIDAVIT THAT POWER OF ATTORNEY IS IN FULL FORCE AND EFFECT

I, ․․․․ of ․․․․, being duly sworn, depose and say:

THAT ․․․․, of ․․․․, as principal, did on ․․․․, 20․․, appoint me in a power of attorney dated ․․․․, 20․․, to execute an affidavit that a specified contingency had occurred;

THAT specified contingency was: ․․․․

THAT specified contingency has occurred.

IN WITNESS WHEREOF, I have hereunto set my hand and seal.

․․․․L.S.

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Witness

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Witness

Subscribed and sworn to before me this ․․․․ day of ․․․․, 20․․.

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Commissioner of the Superior Court

Notary Public

My commission expires: ․․․․