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Free Medical Power of Attorney form template. Prepare for the future by designating an agent to make healthcare decisions for you.

Last updated July 17th, 2024

Free Medical Power of Attorney form template. Prepare for the future by designating an agent to make healthcare decisions for you.

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A Medical power of attorney form enables an individual (known as the principal) to designate an agent who will be responsible for making healthcare decisions on their behalf. The agent’s authority becomes effective only when the principal becomes incapacitated and is unable to make decisions on their own. This incapacity must be confirmed in writing by the attending physician.

Standard Power of Attorney Forms

Statutory Forms: By State

 

Medical Power Of Attorney Forms: By State

Alabama Alaska Arizona Arkansas California
Colorado Connecticut Delaware Florida Georgia
Hawaii Idaho Illinois Indiana Iowa
Kansas Kentucky Louisiana Maine Maryland
Massachusetts Michigan Minnesota Mississippi Missouri
Montana Nebraska Nevada New Hampshire New Jersey
New Mexico New York North Carolina North Dakota Ohio
Oklahoma Oregon Pennsylvania Rhode Island South Carolina
South Dakota Tennessee Texas Utah Vermont
Virginia Washington West Virginia Wisconsin Wyoming

Choosing a Healthcare Agent

medical-power-of-attorney-health-care-agent

What is a Healthcare Agent?

A healthcare agent, also known as a surrogate or proxy, is an individual you select to make medical decisions in case you cannot do so in the future. This person should be a close relative or trusted friend who knows you well and whom you trust to speak on your behalf. In most states, your healthcare agent can make decisions for you anytime you cannot make medical decisions, not just at the end of life.

How to Choose an Agent?

When choosing a healthcare Agent, have open discussions with the potential candidates to be the Agent by discussing your values, quality of life concerns, anticipated medical issues, and possible treatments. Since unexpected situations can arise, your Agent should be able to make decisions based on their understanding of your values and what you consider a meaningful life. These discussions are complex, and your perspectives may change.

Your healthcare agent should:

  • Know you well
  • Remain calm in a crisis
  • Understand how you would make decisions if you were able to
  • Do not hesitate to ask questions and advocate to doctors
  • Comfortably communicate with your family

FAQs 

medical-power-of-attorney-form-FAQs

How do you get a medical power of attorney form?

We provide free medical power of attorney form templates. Download our PDF form above.
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What is a Medial POA Power of Attorney Form?

A Medical or Healthcare Power of Attorney is a legal document that grants an individual, usually the healthcare agent or proxy, the authority to make medical decisions on behalf of the principal if they are unable to do so themselves due to incapacitation.

How to become a Medical Power of Attorney?

The process to become a Medical Power of Attorney includes:

  • Understand and be familiar with the roles and responsibilities of being a Medical POA
  • Legal Requirements – Each State has its own set of rules
  • Select the Person appointing someone they know they can trust.
  • Document – Create a POA document in a format that clearly outlines the terms.
  • Include Instructions on decision-making
  • Witnesses and Notarize – Check with local laws if these need to be included
  • Copies
  • Register and File
  • Review

Does Durable POA cover Medical?

To ensure the Durable POA covers Medical, create a document called a durable power of attorney for finances and healthcare. This document combines financial and medical decision-making powers and allows them to appoint a trusted person to make decisions on their behalf in case of incapacity.

What is a Medical Durable Power of Attorney?

The Medical Durable Power of Attorney (MDPOA) is a legal document that gives an individual, referred to as the “principal,” to appoint another person, known as the “agent” or “attorney-in-fact,” to make healthcare decisions on their behalf if they become incapable of doing so themselves.

What is a Health Care Power of Attorney?

A Health Care Power of Attorney (HCPOA) is a legal contract that lets someone choose another person to make their healthcare decisions if they can’t. It’s part of advance care planning.

What are the Medial POA responsibilities?

The responsibilities include:

  • Making healthcare decisions that align with the wishes of the principal.
  • Consulting with healthcare professionals for making medical decisions.
  • The Medical POA should treat the patient with the principal’s values, morals, and preferences.

Medical Power of Attorney Form: Preview Example 

PDF Template Sample

Medical Power Of Attorney Form 1

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