Advance Healthcare 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

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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

KENTUCKY ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Kentucky Advance Directive | Medical POA | Healthcare Template

A Kentucky Advance Directive Medical Power of Attorney (MPOA) is a legal form that lets the “principal” choose an”agent”/”attorney-in-fact” to make healthcare decisions for them if they can’t do so themselves. This form is important because it puts in writing the person’s healthcare wishes are followed when they cannot make decisions on their own.

Standard Power of Attorney Forms – PDF

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Kentucky Living Will Directive Act

Kentucky Medical Power of Attorney Form Sample

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CALIFORNIA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf California Advance Health Care Directive / Medical Durable Power of Attorney

A California advance health care directive, which combines a medical power of attorney and a living will, enables an individual to designate an agent to make medical decisions and convey end-of-life treatment preferences. A statutory form is required by California residents.

Standard Durable Power of Attorney Forms

Registering Advance Directive

An individual can register an advance directive by completing the registration form (SFL-461) and attaching a $10 check payable to the Secretary of State.

Source: § 4800

Three Options Available for Form Revocation

  1. Fill and sign the revocation form
  2. When the Agent is a spouse, the form will be revoked if the marriage dissolves due to death or legal divorce.
  3. A new form replaces the current one.

Source: § 4695

What happens if you do not have a Health Care Advance Directive Form and you are unable to make decisions for yourself in California?

In California, if you do not have an Advance Directive and cannot communicate your wishes, there is no standard procedure for someone else to decide for you. The rules can also apply to minors, certain types of treatment, or pregnant women. While some states allow for a verbal appointment of a decision-maker, this information is focused on planning for situations where you cannot make decisions for yourself and does not cover verbal appointments.

Source: CDSS – Your Right To Make Decisions About Medical Treatment

California Advanced Directive/Medical Durable Power of Attorney Form: Preview Example

MAINE ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Maine Medical Power of Attorney Template

A Maine Medical Power of Attorney (MPOA) lets you choose someone to make healthcare decisions if you can’t. This person is called your agent. They can decide about your medical care, surgery, and end-of-life wishes.

Standard Power of Attorney Forms – PDF

Law Alert ⚖️

The Principal must be of “sound mind” when creating this form.

Maine Advance Health Care Directive Form Sample

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

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LOUISIANA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Louisiana Advance Health Care Directive Agreement | Medical POA

A Louisiana Advance Health Care Directive form lets you state your medical care preferences and appoint another person to make decisions for you. This document makes sure that your medical treatment choices are known and respected by doctors and family.

Standard Power of Attorney Forms – PDF

Law Alert ⚖️

Advance Directives for Behavioral Health Treatment

Louisiana Medical Power of Attorney Form Sample

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DELAWARE ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Delaware Advance Health Care Directive / Medical Power of Attorney

A Delaware Advance Health Care Directive Form allows individuals to specify their end-of-life wishes, such as choices regarding resuscitation and artificial nutrition. If the individual creating the directive cannot do so, they must appoint an agent to make medical decisions on their behalf.

Standard Durable Power of Attorney Forms

Preview Example

Sample

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GEORGIA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Georgia Medical Durable Power of Attorney Template

A Georgia Medical POA Advance Health Care Directive Form is a legal document gives the chosen person the authority to act on behalf of the individual for various legal issues, such as managing money or being a guardian for a minor. The chosen person must always put the individual’s best interests first and should show the completed and signed form when acting on behalf of the individual.

Standard Durable Power of Attorney Forms

Preview Example

Sample

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CONNECTICUT ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Connecticut Advance Health Care Directive / Medical POA

A Connecticut Advance Health Care Directive Form allows individuals to appoint a healthcare agent and specify their end-of-life preferences for situations where they cannot communicate.

Standard Durable Power of Attorney Forms

Preview Example

Sample

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HAWAII ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Hawaii Health Care Advance Directive / Medical Power of Attorney

A Hawaii Medical Power of Attorney is a document that authorizes an individual to handle your legal and medical matters. The person granting this authority is the “Principal,” and the individual or organization receiving it is called the “Agent.” This Power of Attorney is designed explicitly for Hawaii residents and can be used in all areas of the state including Maui County, Honolulu County, Hawaii County. This document can edited and tailored to your situation.

State Definition: Haw. Rev. Stat. § 327E-2

Standard Durable Power of Attorney Forms

Hawaii Advance Healthcare Directive: Checklist

Page two of the ‘Under Hawai’i Law’ document. 

Revocation

You can notify your physician of your decision to modify or cancel your medical power of attorney, thereby revoking your agent’s authority to decide on your behalf.

Source: §327E-4

What happens if you do not have an Advance Directive Medical Power of Attorney in Hawaii?

If you don’t have an Advance Directive in Hawaii and cannot communicate your wishes, the healthcare provider must inform “interested persons.” These individuals are responsible for making efforts to reach an agreement about your medical treatment. The proxy decision-maker should be someone close to you and likely to know about your preferences for medical decisions. Interested persons may include a spouse, parent, adult child, sibling, grandchild, or close friend.

Source: HI §327E-4

Optional Form

ADVANCE HEALTH-CARE DIRECTIVE: §327E-16 Optional form

Hawaii Advance Health Care Directive: Preview Example

Sample

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