advance directive

ARKANSAS ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Arkansas Advanced Directive / Medical Durable Power of Attorney

An Arkansas medical power of attorney allows an individual (the principal) to designate an agent to make medical decisions on their behalf. This includes authority over financial or medical matters, although the agent can be assigned to handle any legal matter on behalf of the principal.

Standard Power of Attorney Forms – PDF

Law Alert ⚖️

Arkansas Statutes – Arkansas Healthcare Decisions Act

Source: Ark. Code § 20-6-103

What happens if you do not have a Health Care Advance Directive form in Arkansas?

If you do not have an Advance Directive in Arkansas and are unable to communicate for yourself, the healthcare provider will find a surrogate decision-maker for you.

Who is the Surrogate?

The surrogate must be an adult who has shown special care and concern for you, knows your personal values, is reasonably available, and is willing to take on this role. The healthcare provider will consider the surrogate’s ability to make decisions based on your wishes or best interests, their relationship with you, and their demonstrated care and concern.

How will the Surrogate be chosen?

The healthcare provider will first consider your spouse (if not legally separated), then an adult child, then a parent, then an adult sibling, followed by any other relative or person who meets the requirements.

What if there are no Surrogate options?

If no surrogate is available, the healthcare provider will decide after consulting with an institutional ethics committee or a second physician. Your healthcare provider or employees cannot be your surrogate, except for a designated relative.

Source: Arkansas Code §20-6-105: Designation of Surrogate

Sample Arkansas Advanced Directive Form

IOWA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Iowa Advance Directive Health Care Representative Agreement | Medical POA

An Iowa advance directive form is a legal document that enables individuals to specify their preferences for medical treatment and appoint a healthcare proxy if they cannot communicate or make decisions for themselves.

Standard Power of Attorney Forms – PDF

Iowa Physician Orders for Scope of Treatment (IPOST)

Iowa Advance Directive PDF Sample

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KANSAS ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Kansas Advance Directive Health Care Representative Agreement

A Kansas advance directive is a legal document that lets you to choose your medical treatment preferences in case you are unable to communicate your decisions. This can include your choices regarding the types of medical care you want or do not want, and also appointing a healthcare proxy (also known as a durable power of attorney for healthcare) to make decisions on your behalf.

Standard Power of Attorney Forms – PDF

Why is a Kansas Advance Directive Important?

Future Medical Wishes are Followed

By knowing someone you trust can make decisions when you cannot.

Reduces Stress for Loved Ones

It alleviates the burden on family members and loved ones from making difficult medical decisions during stressful times.

Legal Clarity

Provides clear legal guidelines to healthcare providers,  in accordance with Kansas law.

Key Elements of the Advance Directive Health Care Poxy Form

Living Will

This part outlines the types of treatments you want/do not want if you are terminally ill or permanently unconscious. This can include decisions about life-sustaining treatments such as mechanical ventilation, resuscitation (CPR), and artificial nutrition and hydration.

Durable Power of Attorney for Healthcare

This section allows you to designate a healthcare proxy that can make medical decisions for you. This person should understand your values and wishes regarding medical treatment.

Obtaining the Advance Healthcare Directive Form Online

  1. Simple Forms: Simpleforms.com provide free Kansas Advance Directive template downloads.
  2. Kansas Department of Health and Environment: The Kansas Department of Health and Environment (KDHE) has the resources and forms for advance directives. You can find downloadable templates and instructions for completing them on their website.
  3. Healthcare Providers: Many hospitals and healthcare providers offer advance directive forms and assistance in completing them. Contact your healthcare provider for more information.
  4. Online Resources: Websites like AARP, CaringInfo, and the National Hospice and Palliative Care Organization (NHPCO) offer state-specific advance directive forms and guides.

 

Kansas Advance Directive PDF Template Sample

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INDIANA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Indiana Health Care Representative Agreement | Medical POA | Healthcare Proxy

An Indiana Health Care Representative Agreement (Healthcare Proxy) is a legal document used to appoint an agent to make medical care decisions on behalf of an individual if they are unconscious, incapacitated, or mentally incompetent.

Standard Durable Power of Attorney Forms

heaathcare-advance-directive-medical-power-of-attorney-form

Law Alert ⚖️

Indiana State Laws – Health Care Advance Directives, Article 36, Chapter 7

Legal Definition of “Power of Attorney” in Indiana

“”Power of attorney” means a writing or other record that grants authority to an attorney in fact or agent to act in place of a principal, whether the term “power of attorney” is used. The term refers to all types of powers of attorney, including durable powers of attorney, except for the following:

(1) A power to the extent it is coupled with an interest in the subject of the power, including a power given to or for the benefit of a credit in connection with a credit transaction.
(2) A proxy or other delegation to exercise voting rights or management rights with respect to an entity.
(3) A power created on a form prescribed by a government or governmental subdivision, agency, or instrumentality for a governmental purpose.”

Source: § 30-5-2-7

Legal Definition of “Health Care” in Indiana

“”Health care” means any medical care, treatment, service, or procedure to maintain, diagnose, treat, or provide for the principal’s physical or mental well-being. The term includes the providing of nutrition and hydration through intravenous, endotracheal, or nasogastric tubes.”

Source: Ind. Code § 30-5-2-4

Indiana Health Care Representative Agreement Template: Preview Sample

Example

https://simpleforms.com/wp-content/uploads/2024/07/INDIANA-ADVANCE-DIRECTIVE-MEDICAL-DURABLE-POWER-OF-ATTORNEY-FORM.pdf

MPOA ADVANCE HEALTHCARE DIRECTIVE pdf Medical Power of Attorney / Advanced Directive Templates

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

By State

Statutory Forms: By State

 

Alabama – Advance Directive: § 22-8A-4(c)(4)
Alaska – Advance Health Care Directive: Alaska Stat. § 13.52.010
Arizona – Health Care Power of Attorney: § 36-3224
Arkansas – Durable Power of Attorney for Health Care: Ark. Code § 20-6-103
California – Advance Health Care Directive: PROB § 4701
Colorado – Durable Power of Attorney for Healthcare Decisions: § 15-14-506
Connecticut – Advance Directive: § 19a-575a
Delaware – Advance Health Care Directive: Title 16 § 2505
Florida – Designation of Health Care Surrogate: § 765.202(1)
Georgia – Advance Directive for Health Care: § 31-32-4
Hawaii – Advance Health Care Directive: § 327E-16
Idaho – Living Will and Durable Power of Attorney: § 39-4510
Illinois – Power of Attorney for Health Care: 755 ILCS 35/3(b)
Indiana – Health Care Power of Attorney: 755 ILCS 45/Art. IV
Iowa – Durable Power of Attorney for Health Care Decisions: § 144B.5
Kansas – Durable Power of Attorney for Health Care: § 58-632
Kentucky – Living Will Directive and Health Care Surrogate Designation: § 311.629
Louisiana – Advance Directive: RS 28:223
Maine – Health Care Advance Directive Form: § 5-805
Maryland – Advance Directive: § 5-603
Massachusetts – Health Care Proxy: § 201D-2
Michigan – Durable Power of Attorney for Health Care: § 700.5501(b)
Minnesota – Health Care Directive: § 145C.16
Mississippi – Advance Health-Care Directive: § 41-41-209
Missouri – Durable Power of Attorney for Health Care: § 404.822
Montana – Durable Power of Attorney for Health Care: § 53-21-1304
Nebraska – Power of Attorney for Health Care: § 30-3404
Nevada – Durable Power of Attorney for Health Care Decisions: NRS 162A.860
New Hampshire – Advance Directive: § 137-J:20
New Jersey – Durable Power of Attorney for Health Care: § 26:2H-57
New Mexico – Power of Attorney for Health Care: § 24-7A-4
New York – Health Care Proxy PBH: § 2981
North Carolina – Health Care Power of Attorney: § 90-321
North Dakota – Health Care Directive: § 23-06.5-17
Ohio – Durable Power of Attorney for Health Care: § 1337.17
Oklahoma – Durable Power of Attorney: § 63-3101.4
Oregon – Advance Directive: ORS 127.527
Pennsylvania – Durable Health Care Power of Attorney: § 5471
Rhode Island – Designation of Health Care Agent: § 23-4.10-2
South Carolina – Health Care Power of Attorney: § 62-5-504
South Dakota – Durable Power of Attorney for Health Care: § 59-7-2.1
Tennessee – Durable Power of Attorney for Health Care: § 68-11-1803(b)
Texas – Medical Power of Attorney: § 166.161
Utah – Advance Health Care Directive: § 75-2a-117
Vermont – Durable Power of Attorney for Health Care: 18 V.S.A. § 9703
Virginia – Advance Directive for Health Care: § 54.1-2984
Washington – Durable Power of Attorney for Health Care: § 11.125.100
West Virginia – Medical Power of Attorney: § 16-30-4
Wisconsin – Power of Attorney for Health Care: § 155.30
Wyoming – Medical Power of Attorney: § 35-22-403

Medical Power Of Attorney Forms: By State

Choosing a 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.
Box content goes here.

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 Form 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 Power of Attorney 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.

Sample Medical Power of Attorney Form

MISSISSIPPI ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Mississippi Advance Health Care Directive Medical Power of Attorney

This Mississippi Advance Health Care Directive Form lets individuals to chose their medical treatment preferences and appoint a healthcare Agent that cab make medical decisions in any event they cannot do so themselves.

Standard Power of Attorney Forms – PDF

Mississippi Advance Health Care Directive Medical Power of Attorney Form

Preview Sample

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MICHIGAN ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Michigan Medical Power of Attorney Advance Health Care Directive

A Michigan advance health care directive is a legally binding document allowing the Principal pick their preferences for end-of-life medical care and nominate an Agent to make future medical decisions for them if they cannot communicate in the future.

Standard Durable Power of Attorney Forms

Michigan Advance Health Care Directive Sample

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MINNESOTA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Minnesota Medical Power of Attorney Advance Health Care Directive

A Minnesota medical power of attorney advance health care directive form is a legal document allowing individuals to outline their medical care preferences if they cannot make decisions.

Standard Durable Power of Attorney Forms

State Forms

  • MN State Version – PDF
  • Statutory Short Form – PDF

Minnesota Advance Health Care Directive Sample

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MARYLAND ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Maryland Medical Power of Attorney Advance Health Care Directive

A Maryland Advance Health Care Directive is a legal written form that is used by individuals to pick their medical care preferences and chose an Agent to make the medical decisions if they cannot do so themselves.

Standard Durable Power of Attorney Forms

Maryland Advance Health Care Directive Sample

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MA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Massachusetts Advance Health Care Directive Templates

A Massachusetts Advance Healthcare Directive is a legal document that lets individuals chose their preferences for medical treatment and pick a healthcare proxy to make decisions on their behalf if they become incapacitated.

Standard Durable Power of Attorney Forms

Law Alert ⚖️

Massachusetts Statutes – Health Care Proxies

Massachusetts Advance Health Care Directive Sample

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