California Medical Power of Attorney (POA) Form

In California, the Medical Power of Attorney (MPOA) is a part of the Advance Healthcare Directive form. If you download the document via the Internet, you will see this very title on the top of the page. The medical power of attorney form consists of five parts:

  • Part 1 — Medical Power of Attorney. In this part, the principal is allowed to choose a trustworthy person to participate in decision-making regarding health care when the principal has some severe medical problems. Serious medical situations can be of different kinds, including a coma, permanent unconscious state, or other incurable physical or mental condition. It is a good idea   to prevent your close relatives and friends from any confusion and making tough decisions. So, the appointed agent has a legal right to act in such critical situations in accordance with the declarant’s wishes. The agent will have to make decisions regarding life-saving or end-of-life treatment. The attorney (or agent) can choose whether to stop or continue treatment to keep the declarant alive.
  • Part 2 and 3 — Instructions for health care. This part is similar to a living will form that ensures the fulfillment of adult residents’ wishes in difficult medical situations, including the declarant’s becoming completely mentally and physically incapable of making health care decisions themselves. The principal can give specific instructions concerning life-sustaining (such as artificial nutrition or respiration) and end-of-life  (such as organ donation) treatment. It is unnecessary to fill out this part if you are certain that the agent appointed in the first part will make the right decisions.
  • Part 4 — Primary Physician. In this part, an individual has the right to choose a doctor who will be the first one to oversee the care and decide what treatment is best for you.
  • Part 5 and 6 — Signing of the document. This part is mandatory to fill out. It is required that two competent witnesses should be asked to acknowledge and provide their signatures. Their signatures indicate that the declarant is of sound mind when completing the form and that the whole process of creating the form is legal.

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California Laws and Requirements

Following CA Prob Code § 4701 (2019), it is essential that the form be signed by two appointed witnesses and verified by a notary public. The document is considered to be invalid unless they sign the paper. You can find all the basic information about the form and other requirements in the section.

The law requires that you make several copies of the document and distribute them to your primary doctor or to any other healthcare worker that is responsible for providing you with medical treatment. Do not forget to give a copy of the paper to your agent and inform them about all specific wishes and requirements. Ensure that your agent is fully aware of all imposed responsibilities and understands what they are to do.

In California, the law states that you can add two additional agents to make medical decisions for you. A successor agent is necessary if the agent assigned earlier has become unable to carry out responsibilities due to some illness or death.

According to CA Prob Code § 4701, if you consider completing a medical power of attorney, there are certain limitations set on your agent. Keep in mind that your doctor cannot be an attorney. You can find the full list of limitations in the section.

California Medical Power of Attorney Form Details

Document Name California Medical Power of Attorney Form
State Form Name California Advance Health Care Directive
State Laws California Probate Code, Sections 4680 to 4691
Signing Requirements Notary Public OR Two Witnesses
Who Can’t Be the Agent? Section 4659
Who Can’t Be the Witness? Section 4674(c)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Filling Out the Form

In the state of California, the whole document consists of seven pages, but we focus on the MPOA form, so there are only five of them that you are to fill out. If you follow our step-by-step instruction, the process of creating the form will become much easier and quicker.

  • Download the Template

To start filling out the form, you are to download it on your computer or laptop. You can make use of our form building software that helps you to download the form very quickly. Do not forget to print it to provide all the necessary signatures and notarization.

  • Assign Your Agent 

The form starts with designating an attorney or several agents. First and foremost, choose a person who will take the responsibility of deciding what is best for you when there is no hope for improvement of your medical condition. When deciding to complete the form, make sure that the person you want to assign as an agent is someone you can rely upon and entrust such serious decisions to. You are to add the agent’s full name, address, ZIP code, and personal contacts (telephone numbers).
Agent assignment of California medical power of attorney form

  • Appoint Additional Agents

As we have pointed out earlier, if the agent you have chosen in the first place has become unable to take responsibilities and perform tasks on your behalf due to a severe illness, death, or some other reason, you can choose another agent to do it. You can choose whether to fill out the section or not. The form allows you to designate a second successor agent. The principle must enter the personal details (names, addresses, contacts) of the agents.
Additional agents appointment of medical power of attorney template for California

  • Insert Additional Instructions to Your Agent (If Necessary)

Read the statement regarding your agent’s medical authorities carefully. If you think that some of your wishes have not been fulfilled, leave additional instructions in the blank line below. You can either limit or expand powers delegated to your agent.
Section for additional instructions of mpoa document for California

  • Tick the Box (If Needed)

Check the box if you don’t want the form to come into effect only when your physician provides evidence that you have become unable to make decisions regarding your own care.
Part for ticking the box of a medical power of attorney for California

  • Leave Additional End-of-Life Instructions (If Necessary) 

After you have finished reading Part 1.4 of the document, add some additional end-of-life (donation of organs or autopsy) instructions to be considered and fulfilled by the agent.
Additional end of life instrcutions part of medical power of attorney template for California

  • Sign the Paper

Proceed to Part 5 and provide all the required signatures. First and foremost, the form demands that the declarant sign the document, insert the date, and enter their personal details. Then ask two qualified witnesses to acknowledge the legal nature of the document and sign the form. The witnesses are also to provide personal info (names, addresses).
Signing part of a California medical power of attorney form

  • Verify the Document

As the law states, the form must be acknowledged and signed by a notary public. The notary agent must insert the date of the form’s execution and the place in which it took place.
Document verifying section of a California mpoa document

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Published: Jul 29, 2022