New Jersey Medical Power of Attorney (POA) Form

The‌ New Jersey Health Care Proxy Directive (Medical POA) Form is recommended for all adult citizens, regardless of their health status, in case of an unforeseen incident. The New Jersey Health Care Proxy Directive (Medical POA) Form is a special kind of document created by the principal if the principal is unable to make decisions about his or her health care. In a medical power of attorney form, a principal refers to an individual who will be an attorney making health care decisions instead of a principal. The attorney will be able to use his powers if the state of the principal does not allow him to do this on his own. The recognition of the principal as incompetent is possible for several reasons: as a result of an accident that resulted in serious injuries, general anesthesia, coma, serious illness.

The New Jersey Health Care Proxy Directive (Medical POA) Form must be signed with two witnesses for the document to be considered valid in the state. We advise you to choose an individual as an attorney to whom the principal fully entrusts his health care issues. At the same time, as an attorney, it is worth choosing a person who is not a relative or heir of the principal so that this does not affect his decisions regarding the principal’s healthcare. ‌

New Jersey power of attorney forms – download more power of attorney forms for New Jersey along with guidelines.

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New Jersey Laws and Requirements

According to  § 26:2H-57 law, The‌ New Jersey Health Care Proxy Directive (Medical POA) Form must be signed in the presence of two witnesses 18 years of age or older. Upon signature of the New Jersey Health Care Proxy Directive (Medical POA) Form. This type of document does not need to be notarized for it to be valid on the territory of the state of New Jersey.

The‌ New Jersey Health Care Proxy Directive (Medical POA) Form is recommended for every adult citizen, regardless of health status. The attorney will have the power 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.

New Jersey Medical Power of Attorney Form Details

Document Name New Jersey Medical Power of Attorney Form
State Form Name New Jersey Durable Power of Attorney for Health Care
State Laws New Jersey Statutes, Sections 26:2H-53 to 26:2H-67
Signing Requirements Notary Public OR Two Witnesses
Who Can’t Be the Agent? New Jersey Statutes, Section 26:2H-58(2)
Who Can’t Be the Witness? New Jersey Statutes, Section 26:2H-56
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Steps to Fill Out the Form

If you are already familiar with the necessary aspects of making The‌ New Jersey Health Care Proxy Directive (Medical POA) 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.

  • Indicate who is the principal and attorney

In the first part of the document, you need to identify the identity of the principal and the attorney. To do this, in the first part, you need to enter your (principal) full legal name and contact information (place of residence, email, and contact phone number). After that, you need to enter the full legal name of the attorney and his contact information (place of residence, email, and contact phone number).
Principal and attorney indication section of New Jersey medical power of attorney form

  • Indicate other attorneys

The next step in filling out the form is to identify two additional attorneys. Additional attorneys will receive attorney powers if the first attorney is unable to make decisions regarding the health of the principal. As in the first section of the document, you need to enter the full legal name and contact information of one additional attorney first, and then the full legal name and contact information of another additional attorney.
Other attorneys indication section of New Jersey medical power of attorney template

  • Complete the special instructions section

Optionally, the principal can complete a section with specific instructions regarding the powers of the attorney. In this section, the principal can indicate what powers the attorney has, what powers the attorney cannot use, and when the attorney can use his powers. There will be two statements before the principal, one of which will give the attorney the right to decide on life-supporting procedures. The other statements will contain information that the attorney does not have the right to make decisions about life-supporting procedures. The principal needs to put his initials in front of one of these statements. In the same section of the document, there is a grave with special instructions. If the principal does not want to give specific instructions, this section of the document can be left blank.
Special instructions part of a medical poa for New Jersey

  • Indicate the individuals who will have copies of the document

One of the last steps in filling out the form is to specify the individuals who will keep copies of the document. The principal must indicate at least two individuals who will keep copies of the document and their contact information, indicating residence address.
Individuals with copies indication section of a New Jersey mpoa

  • Sign the form

If you agree with all the affirmations and parts of this form, you need to enter your full legal name, address, contact phone number, and email. The attorney and witness must also fill in their full legal names and contact info and put the signatures.
Signing section of a medical poa form for New Jersey

seal of new jersey state

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Published: Nov 19, 2020