Missouri Medical Power of Attorney (POA) Form

The Missouri DPA for HealthCare is an official form that is created by an individual with the aim of giving another individual the credentials to take responsibility for making decrees concerning the healthcare of the individual who creates the form. The individual who creates the medical power of attorney form, hereinafter the “principal,” appoints an individual who will take responsibility for making decrees concerning healthcare, hereinafter “the attorney.” This form is created so that the concerns of the principal regarding healthcare are respected on the chance that the principal can’t make decrees concerning their healthcare, being declared incapable. The attorney appointed by the principal will be able to take responsibility for making decrees concerning the treatment of the principal, the conduct of healthcare procedures, the appointment of life-supporting procedures, and so on. In order to make a Missouri Durable Power of Attorney for HealthCare Form, the Missouri DPA for HealthCare Form must contain signatures of two witnesses, and the document must be notarized after signing.

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Missouri Laws and Requirements

According to § 404.800 to § 404.872 Missouri, the DPA for HealthCare Form must be signed while two witnesses of 18 years of age or older are present. Upon signature of the Missouri DPA for HealthCare Form, the form must be notarized, and a state seal must be affixed. Missouri DPA for HealthCare Form is recommended for every adult citizen, regardless of health status. The attorney will be enabled to take responsibility for making decrees concerning the principal’s healthcare, including the chance of an accident. The original version of the form should be kept by the attorney in a safe but easily accessible place.

Steps to Fill Out the Form

If you are already familiar with the necessary aspects of making a Missouri Durable Power of Attorney for HealthCare Form and are ready to start filling out a form, we advise that you familiarize yourself with the detailed step-by-step instructions below. Avoid possible mistakes and shortcomings.

  • Download the form

Download the form on our website to fill it out electronically or print it out and fill it out in. To ensure the best result, use our form building software. You can download the form in any format that suits you best.

  • Identify the principal

In the first box of the Missouri DPA for HealthCare Form, you need to fill in the principal’s full legal name and the principal’s contact info (telephone number, residential address, and email).
Principal identification section of Missouri medical power of attorney document

  • Identify an attorney

In this section of the DPA form, the principal needs to identify the individual who will take all responsibility for making decrees on behalf of the principal if he or she is declared incapacitated by a professional doctor. The attorney must be of legal age and not be a relative or heir of the principal. Needless to say that we would advise that you choose an individual as an attorney whom you fully trust and are confident that the attorney will take responsibility for making decrees concerning your health care responsibly. In this part, you need to provide the full legal name of the attorney and the contact info (residential address, telephone number, and email).
Attorney indication section of mpoa for Missouri

  • Specify effective date

Here, set the date from which the attorney will be eligible to use their authority. If you want the attorney to have the credentials to use their powers from the moment of signing the form, you need to identify this in this part. If you want the attorney to have the credentials to use their authority only if you are found incapacitated, you must also identify this in this part.
Effective date specification part of Missouri medical power of attorney template

  • Define the powers of the attorney

Here, you need to agree or disprove the affirmations that describe the failure and responsibility of the designated attorney. For every affirmation the principal agrees with, they need to initialize. If the principal disagrees with any of the affirmations, no initials are put in front of them, and the attorney cannot use the powers described in the affirmation. In a separate box, the principal is able to enter their comments and special instructions. This is necessary if the principal partially agrees or disagrees with any of the affirmations on the list.
Part for defining powers of attorney of a Missouri medical poa

  • Sign the form

If you do agree with all the affirmations and parts of this form, enter your full legal name, address, contact phone number, and email. The attorney and witness must also put their full legal names and contact info and add their signatures.
Signing section of form of medical power of attorney for Missouri

  • Notarize the document

Once you, the attorney, and the witness sign the form, you need to notarize the form to ensure it is valid throughout the state. To do this, you need to submit the form to the notary. The notary will fill out the necessary fields and put the official state seal. The original version of the form should be kept by the attorney in a safe but easily accessible place.
Notarization part of a Missouri medical power of attorney

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Published: Nov 19, 2020