Medical Power of Attorney Form

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A medical power of attorney is used to give someone the legal right to make medical decisions on behalf of the principal. This document can be limited in the sense that it will only be valid during a certain period of time, such as if you're unable to make those decisions on your own. In many states, this document may be known as an advance healthcare directive or an advance directive. Depending on the state where you live, this form may need to be notarized.

What is a Medical Power of Attorney?

A Medical Power of Attorney grants to someone someone else, the power to act on your behalf when it comes to medical decisions. A Medical Power of Attorney covers medical care decisions only and often only for the period of time during which you are unable to make these decisions for yourself.

A Medical Power of Attorney legally authorizes a specified person, the ‘Attorney-in-fact’, to make health care decisions and handle medical issues on behalf of the 'Principal', who is unable to do so themselves. It can allow this trusted person to continue acting on the principal's behalf even if they become incapacitated or unable to communicate their medical wishes.

If there is no power of attorney in place and an unfortunate set of circumstances leaves a person unable to consent to medical treatment or make important medical decisions for themselves, their family or friends may need to go to court to obtain the authority to handle that person's medical affairs and make these decisions on that person's behalf.

Other Names for a Medical Power of Attorney

  • Medical Power of Attorney Directive
  • Durable Power of Attorney for Health Care
  • Health Care Power of Attorney
  • Advance Health Care Directive
  • Advance Directive

Associated Terminology

  • Attorney-in fact: The person you appoint to handle your medical affairs can be referred to by a variety of names, including: ‘attorney-in fact’, 'agent,' or 'representative', or similar. This person is legally obliged to follow the principal's treatment preferences to the extent that they know about them.
  • Pre-Arrangement: The document authorizing Medical Power of Attorney can be drafted in advance of incapacity, so that this power of attorney becomes immediately effective upon the principal becoming incapacitated, or it can be effective for the duration of a person's disability, regardless of capacity to communicate.
  • Incapacity: This refers to the principle being injured, ill, or disabled such that they are unable to communicate or express their wishes or manage their own affairs.

Types of Directives

Another estate planning document called a 'Living Will' or 'health care declaration' is a critically important complement to every Medical Power of Attorney. In fact, some states allow a Medical Power of Attorney and a Living Will to come in the form of one document. Many states, however, require them to be executed separately.

Medical POA vs Living Will

A Living Will only gives specific directions with regard to what life-prolonging treatment you want to receive if you fall into a persistent vegetative state and death is imminent as determined by your physicians. Do you want to be kept alive as long as possible or be allowed to pass away naturally? A Medical Power of Attorney, on the other hand, applies in every other situation. What’s more, if you don't have a Living Will in place, your Attorney-in-fact, will be able to make decisions for you regarding life-prolonging treatment as well as.

What Can You Use This Power of Attorney Form For?

You can use this medical power of attorney form to authorize someone to manage any type of decision-making regarding medical treatments or health care on your behalf, including:

  • Health care plans
  • Surgery
  • Drug treatments
  • The withdrawal of treatment

Do You Need a Medical POA?

People who may find this legal document useful:

  • A person anticipating, needing to, or wishing to plan for all medical eventualities
  • An Attorney-in-fact who has power of attorney delegated to them

Components of a Medical POA

Your Medical Power of Attorney should include the following components:

  • The name and address of your primary Attorney-in-fact
  • The names and addresses of alternate Attorneys-in-fact (alternate agents)
  • A HIPPA Release: This will allow your health care provider to talk freely with your Attorney-in-fact so that he or she can understand your medical situation and the choices you have and have access to your medical records.
  • A list of the powers given to your Attorney-in-fact
  • Optional guidance for your Attorney-in-fact: Here you can express your goals regarding the making of medical decisions if when you become terminally ill and or have some other extreme situation. Which is most import to you, comfort, preserving your mental functions, or staying alive as long as possible? How aggressively do you want to be treated if, for example, you have severe brain damage or brain disease, a stroke, or severe Alzheimer's disease or mental health issues?
  • A Living Will or advance health care directive: These are instructions to be followed by your Attorney-in-fact and doctor if you become permanently unconscious or have an end-stage medical condition. Do you want aggressive medical care to preserve life for as long as possible, or is comfort and quality of life more important to you?
  • An option to consent to organ donation or tissue donation
  • Your signature and the signatures of two adult witnesses
  • Notarization language: Some states require a Medical Power of Attorney to be notarized. In other states, notarization is optional.

Once your medical power attorney has been completed and filed, make sure that all of the necessary parties have copies. This includes, primarily, your doctor, agents, and any family members who you think should know about your wishes.

Additional Considerations

If you do not have a Medical Power of Attorney in place and you become physically or mentally unable to consent to or refuse medical treatment on your own, the following individuals, in order of priority, may be legally authorized (as your health care surrogate) to make medical decisions on your behalf:

  1. A court-appointed guardian or conservator;
  2. A husband, wife, or domestic partner;
  3. An adult child;
  4. An adult brother or sister;
  5. A close friend; or
  6. Your closest relative.

If none of the above individuals are available and willing to serve as your health care surrogate, your attending physician can choose any other person or entity including a public agency, public guardian, public official, corporation, or any other other person or entity permitted by law.

Download a PDF or Word Template

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Sample Medical Power of Attorney


Sample Medical Power of Attorney

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