Virginia 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.

Virginia power of attorney templates – have a look at some other powers of attorney used in the State of Virginia.

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.

Virginia Laws and Requirements

As stated in section § 54.1-2983 of the Virginia state law, signing a form should be accompanied by two witnesses. 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 Virginia 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 Virginia, you (as a declarant) may add two agents (principal and additional) in your health advance directive form.

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.
Data adding part of Virginia medical poa template

3. Choose Your Agent

After you have placed your personal details, proceed to the first section. 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.
Agent choosing section of a Virginia mpoa

4. Add Additional Agent

In Virginia, 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 number and home address, you also need to state his or her mailing address and full legal name.
Additional agent adding part of Virginia medical power of attorney document    

5. Fill out the Instructions for Your Agent

In this section, you should leave the instructions for your health care 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. Opt for the items on the list. If you don’t agree with some points, you can cross them out.
Agent instructions part of medical power of attorney for Virginia

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 section of medical poa document for Virginia

7. Insert the Information about the Life-Sustaining Therapy Preferences

The second section of this document introduces three parts. In every part, 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.
Life-sustaining therapy preferences indication section of Virginia mpoa form

8. Specify the Information about the Donation 

In the third section, you can choose whether you want to donate your organs or not (and which particularly). Check only one box that is the most preferable for you. The next blank lines are for your additional preferences that are not mentioned by the authors.
Part for information about donation of medical power of attorney template for Virginia

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 and add the relevant date. If you are physically unable to do it, appoint a representative to sign the paper on your behalf.
Signing part of Virginia health care advance form

10. Ask Two Witnesses to Sign

Two witnesses should sign and add the relevant data. Remember that none of your witnesses can act as your agent.
Witnesses signing part of Virginia medical power of attorney form

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Published: Nov 23, 2020