A Missouri medical power of attorney is a written document that lets you, the principal, name an agent to make health care decisions if you cannot. It is also called a healthcare power of attorney. The FormsPal template adds an advance health care directive, so your agent also has your wishes in writing. Fill it in online, then download and print it.
Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current Missouri law. If you notice an error or outdated information, please contact us.
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Missouri power of attorney templates – click for more Missouri-specific power of attorney templates that you might need.
Missouri's signing rule for a declaration that directs the withholding or withdrawal of death-prolonging procedures says the declaration must be in writing, signed by the person making it, and dated.[2] FormsPal prints this rule on page 9 of the template, above the two witness blocks. Missouri's power of attorney statute also sets rules for nutrition, hydration, and comfort care.[1]
The template combines a power of attorney for health care in Part I with an advance health care directive in Part II. For a general explanation of the document, see our medical power of attorney form guide.
Here is how the signing rule breaks down:
Choose your witnesses with care. Neither witness may be the person who signed the declaration for you at your direction.[2]
The template also has a notary acknowledgment on page 7. Many people have a notary complete it at the signing.
| Document Name | Missouri Medical Power of Attorney Form |
| Form Parts | Part I power of attorney for health care, Part II advance health care directive, Part III general provisions |
| State Laws Used on This Page | Mo. Rev. Stat. § 404.820[1], Mo. Rev. Stat. § 459.015.1[2] |
| Signing Requirements | In writing, signed, and dated. Two or more witnesses if not wholly in the declarant's handwriting[2] |
| Who Can’t Be the Witness? | Anyone under 18, and the person who signed for the declarant[2] |
| Notary Block | Notary acknowledgment on page 7 of the template |
| Avg. Time to Fill Out | 8 minutes |
| # of Fillable Fields | 29 |
| Available Formats | Adobe PDF |
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Missouri's power of attorney statute sets specific rules for decisions about nutrition and hydration. To let your agent direct a health care provider to withhold or withdraw artificially supplied nutrition and hydration, you must specifically grant such authority in the power of attorney.[1] Read paragraph E on page 3 of the template, Refuse Nourishment or Hydration, before you sign.
The statute adds these rules:
Before an agent or physician may authorize withdrawing nutrition or hydration that the patient may ingest through artificial means, the physician must do one of two things:
This FormsPal template has 29 fillable fields across nine form pages. You fill in your name and address, your agent and an alternate agent, your signature and the date, the notary acknowledgment, and the two witness blocks. Everything else is preprinted, including the agent's powers in Part I, the advance health care directive in Part II, and the general provisions in Part III.
The screenshots under each step show the FormsPal Missouri medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.
Nothing to initial. Pages 2 through 5 are fixed text. Section 2 on page 4 says the power takes effect only on the principal's incapacity, as shown by a written statement from the principal's treating physician. Read the preprinted pages, including the advance health care directive, before you sign.
Once you have filled in the template, print it, sign it, and have it witnessed. Then share copies with the people who will carry out your health care decisions and keep the signed original where your agent can find it. If you also want to put your end-of-life treatment wishes in a separate document, see our Missouri living will form.
Fill in the template on this page, then print it and sign it. Missouri's signing rule for a declaration that directs the withholding or withdrawal of death-prolonging procedures says the declaration must be in writing and dated.[2]
Under that rule, a declaration that is not wholly in the declarant's handwriting is signed in the presence of two or more witnesses. Each witness must be at least 18 years old.[2]
Yes. The declaration may be signed by the person making it, or by another person in the declarant's presence and at the declarant's expressed direction. That person cannot also be a witness.[2]
Only if you specifically grant that authority in the power of attorney. This applies to nutrition and hydration supplied by artificial means. No agent may authorize the withdrawal of nutrition or hydration that you can take by natural means with the intent of causing your death.[1]
Before an agent or physician may authorize withdrawing nutrition or hydration that the patient may ingest through artificial means, the physician must do one of two things:
Attorneys in fact must also consider appropriate measures to provide comfort to the patient.[1]
The free FormsPal template has 29 fillable fields across nine form pages. Fill it in with the form at the top of this page, then download and print it. Sign the printed copy with your witnesses, and have a notary complete page 7 if you choose.
The template combines a power of attorney for health care with an advance health care directive, so your agent has your health care wishes in writing. Need a different document? Try our Missouri durable power of attorney, Missouri child power of attorney, or Missouri motor vehicle power of attorney form.
General information, not legal or tax advice.
Unless noted otherwise, the sources below are from the Mo. Rev. Stat..
