Medical Power of Attorney

ALASKA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM 1 pdf Alaska Advanced Directive / Medical Power of Attorney Template

An Alaska advance directive medical power of attorney is a legal document that allows a person to appoint up to two healthcare agents who can make medical decisions for them. This document also enables people to specify their medical treatment preferences for situations when they cannot make decisions for themselves.

Standard Power of Attorney Forms – PDF

What happens if you don’t have an Advance Directive/MPOA form in Alaska?

If you do not have an Advance Directive in Alaska, a decision-maker is determined by the following order of priority:

  1. A spouse, unless legally separated.
  2. An adult child.
  3. A parent.
  4. Adult siblings.
  5. An adult “who has exhibited prior care for the patient, is familiar with the patient’s personal values and morals, and is reasonably available.”

If there is more than one class member, the healthcare provider will follow the majority’s decision. If there is an even split, the primary decision-maker will decide after consultation with the parties.

Source: Sec. 13.52.030., Chapter 13.52 – HEALTH CARE DECISIONS ACT

Sample Alaska Medical Power of Attorney Form

ALABAMA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Alabama Medical Power of Attorney Template PDF | Word | Excel

An Alabama Advanced Directive Medical Durable Power of Attorney form enables an individual to appoint someone else, known as an “agent,” to make crucial decisions on their behalf.

Standard Power of Attorney Forms – PDF

What happens if you don’t have an Advanced Directive/MPOA Form in Alabama?

In Alabama, if you don’t have an Advance Directive/Medical Power of Attorney and you are unable to communicate your wishes, the decision-maker is determined by the following order of priority:

1. A spouse, unless legally separated or divorce proceedings are pending
2. An adult child
3. A parent
4. An adult sibling
5. A surviving adult relative of the following closest degrees of kinship

Note – A committee will be formed and will consist of the attending physician, the ethics committee of the treating facility (if available).

Source: Alabama Code § 22-8A-11

End of Life Services in Alabama

Hospice Services of Alabama – Offers in-home hospice care.

Sample Alabama Medical Power of Attorney Form

ARIZONA ADVANCE DIRECTIVE MEDICAL DURABLE POWER OF ATTORNEY FORM pdf Arizona Advanced Directive / Medical Durable Power of Attorney Template

This Arizona advanced directive medical power of attorney document is created by an individual (the “principal”) in case they cannot communicate with medical staff. This situation can often arise due to conditions like dementia or Alzheimer’s Disease or as a result of recent surgery. A medical power of attorney may be revoked by completing a Revocation Form.

Standard Power of Attorney Forms – PDF

What happens if you don’t have an Advanced Directive in Arizona?

In Arizona, if you cannot speak for yourself and don’t have an Advance Directive or Medical Power of Attorney, the state has a specific order of priority for who can make healthcare decisions on your behalf. The hierarchy is as follows:

1. Spouse: The spouse is the primary decision-maker unless legally separated.
2. Adult Child: If there is more than one adult child, the healthcare provider must seek the consent of the majority who are reasonably available for consultation.
3. Parent: One or both parents can make decisions.
4. Domestic Partner: A domestic partner can decide if the patient is unmarried.
5. Sibling: A brother or sister of the patient can make decisions.
6. Close Friend: A close friend is defined as someone who has shown exceptional care and concern, is familiar with the patient’s healthcare views, and is willing and able to be involved in their care.

If no one from the above categories is available to make decisions, the physician can consult with an institutional ethics committee. If such a committee is unavailable, the physician may consult a second physician to make decisions.

Source: § 36-3231

Sample

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

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

Law Alert ⚖️

Kentucky Living Will Directive Act

Kentucky Medical Power of Attorney Form Sample

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

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

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

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

Next →

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

Next →

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

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

Next →