Minnesota Medical Power of Attorney (POA) Form

The Health Care Advance Directive is a document that allows a person to choose a reliable agent or attorney who will act in critical conditions and situations of crisis. If a person (or a declarant) becomes disabled and unconscious or suddenly faces a vegetative state, coma, or a similar physical condition, the agent appointed by this paper will take care of the decisions regarding the declarant. The agent or attorney will be responsible for continuing or stopping the treatment, accepting or refusing it for the declarant. This is a vital document in the United States, especially for the people that have already gotten sick and have severe disease or those who are older than a certain age. Also, the medical power of attorney form lets the agent or attorney act in case of an accident when the victim has had serious injuries and has become disabled. In the MPA form, you will leave special instructions that depend on your will. These instructions may tell about:

  • Medical care in general
  • Preferred treatment
  • Live-sustaining procedures

And other things tied to your health care in critical conditions. Every state in the US has different rules and laws regarding the health advance directive form. In some states, you will need to notarize the form. Others ask for a witness or two witnesses to make the form valid.

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Minnesota Laws and Requirements

As stated in section § 145C.01 (b) of the Minnesota state law, signing a form should be accompanied by two witnesses and a notary. You should be over 18 (or under this age but have the rights of an adult) and in sound mind.  You are to choose the future agent very carefully because one will make medical decisions for you. An agent can be any adult except for one from the medical staff of the hospital where you get treatment. But if at the same time one is your relative, then one can be. Under Minnesota law, the signatures of you and other people involved should be written. After the signing process, an agent gets access to all your medical records for understanding what the right decision one must make on your behalf. In Minnesota, you (as a declarant) may add two agents (principal and additional) in your health advance directive form. Do not forget to state the type of relationship that connects you with your agent (or agents).

Minnesota Medical Power of Attorney Form Details

Document Name Minnesota Medical Power of Attorney Form
State Form Name Minnesota Health Care Directive
State Laws Minnesota Statutes, Chapter 145C
Signing Requirements Notary Public OR Two Witnesses
Who Can’t Be the Agent? Section 145C.03, Subdivision 2
Who Can’t Be the Witness? Section 145C.16
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Filling Out the Form

We have prepared a detailed guide with all the required steps so you can easily complete the health care advance directive form in Minnesota. You may see this guide below.

1. Download the Template

To start, you need to download the template of the health care advance directive form. To make it simple, use our form building software. The AD form in Minessota consists of three main parts. You can choose to complete the first, the second, or both parts 1 and 2. However, the third part is mandatory: the declarant’s signature and the witnesses’ verification should be placed there. The authors of the form recommend making a sufficient number of copies of your directive: give it to the agent, to your personal physician (if applicable), and to other people that might need it. From time to time, you may re-read your AD and create a new paper if your wish becomes different.

2. Add Your Data

On the first line of the form, you, as a declarant, should place your full name.
Data adding of a AD form for Minnesota

3. Choose Your Agent

After you have placed your personal details, proceed to the first section. Add the name of your agent and the type of relationship that ties you together. Below the name of this person, add his or her best phone number and home address (with one’s city and one’s state).
Agent choosing part of Minnesota medical power of attorney form

4. Add Additional Agent

In Minnesota, you may appoint one additional agent in your form. Below the details of your initially chosen agent, add the information about an additional one. This is needed because sometimes, your initial agent may also become unavailable or unable to act in accordance with your health care advance form. Apart from the telephone numbers and home addresses, you also need to state the type of relationship that connects you with your additional agent (with one’s city and one’s state).
Additional agent adding part of a Minnesota medical power of attorney document

5. Fill out the Instructions for Your Agent

In this section, you should leave the instructions for your agent. They may include all the information about your will regarding your health conditions and medical care, including life-sustaining procedures, treatment, and other aspects.
Agent instructions section of a document of medical poa for Minnesota

6. Add Special Conditions

In the blank field of the next section, you may also add some instructions that can limit or increase the responsibilities of your agent.
Special conditions adding part of a Minnesota mpoa

7. Specify the Information about the Donation and the Burial Process

In these sections, you can choose whether you want to donate your organs (and which particularly) and in what way to be buried (if you want, of course). You can also add the names of people who you want to learn about your last wishes.
Part for information about donation and burial process of Minnesota medical power of attorney

8. Insert the Information about Your Last Wishes

You are free to add some of your last wishes. For example, the name of the physician by whom you want to be treated or a particular medical place where you want to be in case of a serious illness.
Information about last wishes part of mpoa for Minnesota

9. Sign the Healthy Care Advance Form

You, as a declarant, must check the information you have provided several times and then sign the document. If you are physically unable to do it, appoint a representative to sign the paper on your behalf. Ask the representative to insert details regarding their name, full address (information required in all sections in which the identity of a person must be specified).
Signing part of Minnesota health care advance form

10. Ask a Notary to Sign 

A notary should verify the document by signing, adding a signing date, state, county, and full legal name, and putting a seal (if applicable).
Notary signing section of Minnesota medical power of attorney template

11. Ask Two Witnesses to Sign

Two witnesses should sign, add the relevant data, birthdates, and their places of residence (with their cities and their states). Remember that none of your witnesses can act as your agent.
Witnesses signatures part of mpoa for Minnesota

Other Minnesota Forms

Check out our document maker to customize any form found on FormsPal to your preferences. Here is a number of various other fillable Minnesota forms we provide.

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Published: Dec 7, 2020