Utah 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.

Utah power of attorney templates – this particular section can help you learn more about other powers of attorney used in Utah.

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 any other instructions you may think of while leaving your healthcare directive. In the AD form in some states, you also may add wishes regarding the cremation or burning of your body and other thoughts related to the processes that happen to your body after death.

There is no unified sample of such a directive or MPA form in the US. Each state has its own laws and recommendations that regulate the creation of this form. Some states require notarization of the MPA form; in others, you will need to call a witness (or two) to sign the papers.

Utah Laws and Requirements

As stated in section § 75-2a-103 of the Utah state law, You should be over 18 (or under this age but have the rights of an adult) and in sound mind. According to § 75-2a-107(c), the sighing procedure should take place in the presence of one witness. 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 Utah 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 Utah, you (as a declarant) may add two agents (principal and additional) in your health advance directive form.

The AD in Utah is not very long of 4 parts (4 pages). It is not very difficult to fill out.

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 Virginia. 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 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, the place of residence (with the cite, the state, and the zip code), your best telephone and cell phone number, and your birthday.
Data adding section of Utah mpoa template

3.   Proceed to Part I (Section A)

After you have placed your personal details, proceed to the first section. If you do not want to choose the attorney-in-fact, then you can tick this box.
Section for filling out Part I of a medical power of attorney form for Utah

4.      Choose Your Agent (Section B)

You are to choose the future agent very carefully because one will make medical decisions for you. After you have chosen one, add the name of your agent and the mailing address. Below the name of this person, add his or her best phone number and home address (with the cite, the state, and the zip code).
Agent choosing section of Utah medical poa document

 5.   Add Additional Agent (Section C)

In Utah, you may appoint one additional agent in your form. Below the details of your initially chosen agent, add the information about the 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 address (with the cite, the state, and the zip code), you also need to state his or her mailing address and full legal name.
Additional agent adding of Utah mpoa document

6.    Fill out the Instructions for Your Agent (Sections D, E)

The section “Agent’s Authority” already has all the powers of your attorney-in-fact. You are just to read them carefully. They include some information about your will regarding your health conditions and medical care, including life-sustaining procedures, treatment, and other aspects.
Agent instructions part of Utah medical power of attorney template

7.     Add Special Conditions (Section F)

In the blank field of this section, you may also add some instructions that can limit or increase the responsibilities of your agent.
Special conditions adding section of medical power of attorney for Utah

8.    Nominate the Agent as Your Guardian (Section G)

Even though this paper is good for avoiding guardianship, there are some cases when you need a guardian. If the court decides to appoint you one, you can have your agent or your additional agent as a guardian. For this, check the answer ‘Yes’ in section ‘G.’
Part for nominating agent as guardian of Utah mpoa

9.     Specify the Information about Donation and Participation in Medical Research (Sections H, I) 

In these sections, you can choose whether you want to donate your organs or not. This will allow the agent to make the right decision. Check only one box that is the most preferable for you. The same is with participation in medical researches. If you accept this section, you will also accept the results of the clinical trials, even if they are not positive.
Section for information about donation and participation in medical research of Utah medical poa

10.      Proceed to Part II

This part consists of two pages and is called Living Will. This part of this document introduces four options. In every option, you are to choose one preferred alternative that corresponds with your health care wishes and check it. You are free to add some of your own preferences about life-sustaining preferences that are not mentioned by the authors. They should not conflict with the other instructions that you have given in this document.
Section for filling out Part II of Utah medical poa form

11.    Sign the Healthy Care Advance Form (Part IV)

You, as a declarant, must check the information you have provided several times and then sign the document and add the relevant date and the name of your city, county, and state. If you are physically unable to do it, appoint a representative to sign the paper on your behalf.
Signing part of Utah Health care advance form

12.     Ask a Witness to Sign

Below your signature, the witness should sign, add the relevant date, his or her street address, the city, the county, the zip code, and one’s printed name. Remember that none of your witnesses can act as your agent. Also, remember that the AD form notarizing is not required in Utah by law.
WItness signing section of medical power of attorney for Utah

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Published: Nov 20, 2020