South Carolina Medical Power of Attorney (POA) Form

A Medical Power of Attorney or, as introduced in South Carolina, Health Care Power of Attorney certificates serve to create an extra layer of confidence that one’s therapeutic preferences will be completed in case the patient becomes physically or mentally incompetent to delegate his or her wishes oneself.

SC Health Care POA allows the declarant to choose a dependable individual willing to render therapeutic decisions on the declarant’s behalf listed in the form. Therefore the declarant has powers to fully or partially delegate the instructions to his or her person of choice. Following the medical power of attorney form, the principal can authorize the below-listed interests:

  • Initiate or withdraw any therapeutic measures, treatment, or surgeries
  • Consent to artificial feeding, respiration, hydration
  • Accept or decline cardiopulmonary resuscitation.
  • Consent to or refuse pain-relief medication even though it may result in the worst scenario
  • Enter or reject any medical institution
  • Follow anatomical gift instructions.
  • Directive regarding life-sustaining measures

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Deciding the Kind of Treatment

The principal can decide what kind of treatment strategy he or she prefers. The document contains a section that specifies whether the patient wishes to withdraw any medical life-prolonging procedures, or instructs the provider for maximum treatment, or leaves the decision to the attorney-in-action when the time comes.

South Carolina Health Care Power of Attorney claims that the attorney-in-fact obtains the same rights and powers as the declarant unless the declarant specifies the limitations and restrictions. However, if the patient can communicate decisions himself or herself, it will be the only way of performing medical care. The appointed attorney will enter upon the instructions only if the declarant becomes incapable of communicating the choices.

Below you will learn the mandatory requirements that one needs to complete while creating the document for powers transfer.

South Carolina Laws and Requirements

Following South Carolina Code §62-5-503, an individual can delegate instructions and powers to a designated person who will follow these medical treatment preferences when the declarant loses the capacity to communicate the therapeutical choices oneself. The written paper must meet the following requirements:

  • The document must be structured as the form introduced in South Carolina Code §62-5-504.
  • The document must contain the declarant’s signature. If the declarant is physically incapable of signing the document himself or herself, let another person authorize it in the declarant’s name, at his or her witnessing, and by the declarant’s direction.
  • Signatures of two adult witnesses different from the appointed agent must be collected. The witnesses must not be related to the declarant by blood, marriage, and legal family bonds. The witnesses cannot be entitled to the declarant’s estate or get any other kind of beneficiary. The health care provider and the employee of the attending doctor cannot perform witnessing either.
  • South Carolina laws demand notarization of the Health Care Power of Attorney certificate.
  • The designated attorney-in-action must be at least 18 years old. This agent must not be a health care provider or the provider’s spouse when the document is created unless the agent relates to the declarant by family relation.

The revocation is available in oral or written form — the patient must notify either the elected attorney or the medical treatment provider.

South Carolina Medical Power of Attorney Form Details

Document Name South Carolina Medical Power of Attorney Form
State Form Name South Carolina Health Care Power of Attorney
State Laws South Carolina Code of Laws, Sections 62-5-501 to 62-5-518
Signing Requirements Notary Public AND Two Witnesses
Who Can’t Be the Agent? Section 62-5-503(a)(4)
Who Can’t Be the Witness? Section 62-5-503(a)(3)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Filling Out the Form

South Carolina Health Care Power of Attorney form consists of two sections. The first part includes general South Carolina instructions and directions, while the second part is the document that one needs to complete accurately displaying the therapeutical choices. You are welcome to follow our instruction guide as we rely on the SC Code while providing this comprehensive checklist.

  • Download the Template

We encourage you to use our form building software to create the form and start completing the document immediately.

  • Specify the Identity of the Parties 

Submit your legal name and the identity of the appointed agent. You must insert the agent’s name, complete address, and phone numbers. The SC form foresees the chance of unpredictable circumstances when the appointed agent loses the capacity to follow the instructions due to life circumstances or refusal. Therefore, please define two alternate agents that will obtain authority if you render incapable, and the first attorney-in-fact backtracks.
Parties identity specification section of mpoa form for South Carolina

  • Get Acquainted with the HIPAA Authorization

This section contains essential information about HIPAA Authorization. Read the passage accurately and proceed to further paragraphs.
Part about HIPAA Authorization of a South Carolina mpoa template

  • Define the Agent’s Authority

The section sounds like “Agent’s Powers.” Here you must choose the actions to grant your attorney-in-fact. Unless you specify any limitations on the lines of the E section, paragraphs A-D operate. If applicable, declare any wishes that will restrict some powers of the elected agent.
Agent's authority defining part of medical power of attorney document for South Carolina

  • Specify Anatomical Gift Preferences

Place your initials next to the preferred alternative. The paragraph either delegate full powers to the agent or restricts him or her to render donation decisions.
Anatomical gift preferences specification section of South Carolina mpoa

  • Attach the Living Will (if applicable) 

This paragraph includes instructions regarding the Living Will if you have any.

  • Define the Life-Sustaining Therapy Preferences

The document introduces three paragraphs. Place your initials next to one preferred alternative that corresponds with your health care wishes.
Life-sustaining therapy preferences defining section of medical power of attorney template for South Carolina

  • Define Artificial Feeding Preferences

Here you are also to choose between three alternatives. You are empowered to delegate the choices to your designated agent, reject the tube nutrition, or give consent to it. You should provide initials to one of the alternatives. However, if you don’t mark any, your attorney-in-action won’t get powers to render tube feeding decisions.
Artificial feeding preferences defining part of South Carolina medical poa

  • Place Your Signature

To complete the document, you need to write down the date, residency, and signature. Following the document, you, being the principal, should also print your name.
Signature part of South Carolina medical power of attorney form

  • Collect the Witnesses’ Signatures

Submit the data of the two witnesses. This paragraph requires that the declarant provides the names, addresses, phone numbers, and signatures of the two witnesses that accommodate the requirements of South Carolina Code §62-5-503.
Witness signature of South Carolina medical power of attorney form

  • Notarize the Document

Collect the authorization by the notary public. Following South Carolina Code §62-5-503, this condition is mandatory and must be executed.

When all the requirements are satisfied, attach a copy of the signed and notarized document to the medical record.
Notarization section of South Carolina medical power of attorney form

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Published: Nov 20, 2020