Illinois Power of Attorney for Health Care (Medical POA)

Setting up a medical power of attorney form offers its creator peace of mind — such a document becomes a guarantee that somebody you fully trust will be in charge of your affairs. The Illinois power of attorney for health care protects personal welfare, so the person appointed by you will be taking care of your medical care in case you lack the decision-making power due to, for instance, incapacitation. You can combine a medical power of attorney form with other types of Power of Attorney forms but keeping separate documents makes it easier to adjust conditions or revoke just one form instead of revoking all at once. Illinois does not have one standard form for this specific type of document. The composition of the form can differ, but some content is required.

Illinois power of attorney templates – discover other power of attorney documents for Illinois together with instructions.

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Illinois Laws and Requirements

Before proceeding to fill out the form, you need to familiarize yourself with a few definitions. “The principal” is the individual who delegates the health-related powers to “the (health care) agent.” The agent must be at least 18 years old according to the laws of Illinois and cannot be the principal’s attending physician. The agent will receive the authority to act on a broad range of health-related matters. Apart from making decisions concerning any kind of medical care, procedures, and treatments, the agent can resolve the following matters:

  • Performing an autopsy on the principal’s body
  • Donating organs
  • Remains deposition

This is not a full list of powers they will acquire. The Power of Attorney for Health Care Form contains descriptions of the powers delegated to the agent. The signing requirements in Illinois are clear and simple. Only one witness must provide their signature, acknowledging that the signing of the agency has taken place. There are also limitations on who can be a witness. The witness cannot be the agent or somebody related to them. The witness also cannot be somebody who provides health-related services to the principal, and it also cannot be their relative (see the full list on in Section 4-5.1). You have the right to revoke your Power of Attorney. You can simply burn, tear the document apart, or destroy it in a way showing the intent. It is also possible to do so orally, in the presence of a witness.

Illinois Medical Power of Attorney Form Details

Document Name Illinois Medical Power of Attorney Form
State Form Name Illinois Power of Attorney for Health Care
State Laws Illinois Compiled Statutes, Chapter 755, Section 45, Article 4
Signing Requirements One Witness
Who Can’t Be the Agent? Chapter 755, Section 45/4-5
Who Can’t Be the Witness? Chapter 755, Section 45/4-5.1
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

State Peculiarities

In Illinois, a Power of Attorney for Health Care Form always starts with the notice that you have to read. It is not short, but it includes all the necessary information. It explains what the form does and who the health care agent is. It emphasizes the importance of choosing the right person as your agent. Choosing the right person is not enough as you also need to discuss certain matters with them and with your family in advance. You need to define how you feel about suffering, disability, organ donation, and whether the agent should be aware of some of your religious beliefs. You can choose a successor agent who will be making decisions on your behalf if the primary agent cannot do so. You can also choose a third person if the first successor agent cannot perform the duty either. Remember that if you do not have the form, then your physician or your health care provider will contact your family, friend, or guardian. These individuals are called “surrogates.” It is usually beneficial to name your agent yourself as you will be sure that you have chosen the person who can communicate your wishes regarding your health care in the best possible way. You do not need to notarize the form in Illinois. It is often recommended to do so for the simplicity of proving that the signature is genuine, though.

Popular Local Medical POA Forms

Medical power of attorney forms enable you to establish an agent who can take care of your health affairs after you get incapacitated. Below are the states MPOA forms are requested in most regularly.

Filling Out the Form

You can use our form building software to complete the process effortlessly. Otherwise, follow the guide below:

  • Read the notice.

Before proceeding to fill out the Power of Attorney, read the notice at the beginning of the form.

  • State your name.

If you have understood the notice and are ready to assign the agent, write your name and address.
Part for inserting name of a medical power of attorney for Illinois

  • Assign the agent.

Provide the details so that your agent can be identified and contacted in case of an emergency (name, address, and phone number).
Agent assignment section of a mpoa form for Illinois

  • Specify if you want your agent to be your guardian.

Indicate in the form if you wish for the agent to also become your guardian. This is optional.
Part for information about agent as a guardian of Illinois medical power of attorney document

  • Decide on the time of the execution of the form.

One option is that the agent receives the decision-making powers immediately, and the other is that the form will not be applicable unless you are incapacitated. Choose what suits your best by ticking the appropriate box.
Execution time section of a document of mpoa for Illinois

  • Decide whether you would agree to a life-sustaining treatment (optional).

This is an optional stage where you can specify how you want to be treated if your health care providers offer a life-sustaining treatment.
Life sustaining treatment info section of Illinois mpoa template

  • Specify any limitations imposed on your agent’s authority.

You can limit the agent’s powers regarding your health. Specify the limitations in your own words if there are any.
Agent's authority limitations section of medical power of attorney form for Illinois

  • Sign and date the power of attorney form.

Remember to read the form carefully again and make sure that a witness is present when you sign it or that you have told them that the signature is yours.
Part for signing and dating a form of medical power of attorney for Illinois

  • Let the witness sign the form.

The witness needs to confirm that they fit the requirements to be a witness (such as being 18 years old and not being the agent’s relative) and that they have witnessed you signing the form, or that you have told them that the signature is yours. They will need to print their name and provide their address, signature, and date.
Witness signing part of Illinois medical power of attorney template

  • Select successor agents (optional).

As we defined above, successor agents take over the powers if the primary agent could not fulfill them. This is an optional step, but you can name one or two successor agents if you wish. Otherwise, an individual will be appointed following the laws of Illinois.
Successor agents selecting section of Illinois medical power of attorney template

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Published: Jul 23, 2022