Free Medical Power of Attorney Form

What Is a Medical Power of Attorney?

A medical power of attorney names the person who speaks for you on health care when you cannot decide or communicate for yourself. That person is your agent, also called your attorney-in-fact. Depending on the state, you may see the terms proxy, surrogate or representative instead. Your agent follows your wishes and the powers you grant in the document.

Your agent does not need to be a family member. Choose someone who knows you well and understands your health care preferences. Depending on the state, these people cannot serve as your agent:

• Your treating health care provider
• An employee of your treating health care provider
• An owner, operator or employee of a facility where you receive care

Some states make an exception for relatives.

Your agent may have to make critical decisions, including your end-of-life care. Talk through the kind of care you want before you sign.

A medical power of attorney is meant to work when you cannot decide for yourself, so make sure the document you use says so.

A medical power of attorney can give your agent powers such as these:

Consenting to or Refusing Medical Care

Your agent can decide whether to go ahead with the care your doctors recommend when you cannot decide yourself. Naming an agent tells your doctors whom you chose to speak for you.

Choosing Doctors and Care Providers

Your agent can also choose between different medical professionals to provide your care.

Access Medical Records

You can give your agent access to your medical records so they can make informed decisions on your behalf.

Accept or Refuse Life-Prolonging Procedures

You can give your agent the right to decide about life-prolonging procedures, such as a respirator or tube feeding. Your agent should follow your wishes, so talk about the care you would and would not want. Your agent can also choose to pursue those procedures if that is what you would want.

In some states, an agent cannot consent to or refuse treatment over your own objection. In some states, the document must grant authority over tube feeding specifically, so check what your form says.

Provide Relief from Pain

Your agent can decide which kinds of pain control you receive and which medications you take. This is not the same as prescribing them. If your doctor offers morphine or another drug that can make you drowsy, your agent decides whether to accept it or ask for something else.

Organ Donation and Your Remains

Some forms let you state your wishes on organ donation and the care of your remains, such as burial or cremation. Whether your agent has a say after your death depends on the state and the document. If you are a registered organ donor, say so in the document.

These are not all of the powers a medical power of attorney can grant, but they are some of the most common. You can customize the form to grant only some of them. The fewer powers you grant, the less your agent can do in a medical emergency.

Instead of limiting your agent's powers, you can put your wishes in writing in a living will or advance directive. Give your agent a copy and talk through your wishes with them.

Medical Power of Attorney vs. Living Will and Health Care Proxy

Several documents sound alike but do different jobs, and the names change from state to state. Knowing which one you need helps you plan your care and your finances. This is how they differ:

• Medical power of attorney: names an agent to make health care decisions for you when you cannot.
• Living will: states which treatments you want or refuse, such as life support.
• Health care proxy: in some states, the name for the document that appoints your health care agent.
• Financial power of attorney: lets someone handle your money and bills.

Medical POA vs. Living Will

Both of these documents are advance directives, but they are a little different in how they work.

A living will lets you state your wishes about end-of-life care. For example, you can say whether you want life support machines, blood transfusions, or pain medication that could make it hard to stay awake. A medical power of attorney names someone to make those decisions for you.

A living will gives you more control over the treatments it names, but it cannot cover a situation you did not anticipate. With a medical power of attorney, your agent has to understand your wishes and act on them. Your agent can respond to a wider range of circumstances.

Some states have one combined advance directive form for both documents. Other states keep them separate. Check your state's rules on combining them and on how each one must be signed.

Health Care Proxy and Other Names

A health care proxy is not a weaker or separate version of a medical power of attorney. In some states, it is simply the name for the document that appoints your health care agent. Other states use terms such as health care surrogate designation, patient advocate designation or health care representative.

Whatever the name, your agent makes decisions about your care. Paying bills from your accounts takes a financial power of attorney. In some states, a health care proxy cannot be on the same form as a financial power of attorney, so keep them as separate documents.

If you name different people for health care and for money, make sure each one knows your wishes.

When to Use a Medical Power of Attorney

Set up a medical power of attorney well before you need it. Your agent steps in when you cannot make or communicate your own health care decisions, so the document has to be in place beforehand. Any adult can create one. Your agent may need to act in situations like these:

• Complications after surgery
• A car accident or other sudden injury
• A long-term illness or health crisis
• End-of-life care

You must understand what you are signing when you fill out the form. In some states, the witnesses confirm that you appeared of sound mind and free of pressure.

Medical Power of Attorney Signing Requirements by State

This table shows how each state wants a medical power of attorney signed: before witnesses, a notary, either one, or both, along with the statute. The number of witnesses and who may serve as one differ by state. Some states publish their own form. Laws change, so open your state's page or read the statute before relying on a cell.

Steps to Getting a Medical POA

Getting a medical POA takes five steps. You choose your agent, decide on their powers, consider a living will, fill out and sign the form, and handle any other directives. If you have a lawyer, you can ask them to prepare it. Otherwise, you can use a medical POA form.

Step 1: Select an Attorney-in-Fact

The first thing to do is decide who you want to trust as your agent.

Choose someone who understands your wishes, is willing to take on the role, and who you trust with access to your medical records.

Step 2: Determine Health Care Attorney Powers

Once you know who you trust, you can also decide which powers to give them.

Step 3: Decide Whether You Also Want a Living Will

A living will lets health care providers know what you want for end-of-life care.

Some states have one combined advance directive form for both. Other states keep them as separate documents, so check your state's rules.

Step 4: Fill Out Your Medical Power of Attorney Form

Complete every required part of the form. If your state has its own form, follow it.

How the form must be signed depends on the state. Depending on the state, you may need:

• Two witnesses
• One witness
• Witnesses or a notary public
• In at least one state, both witnesses and a notary public
• In a few states, neither

Many states limit who may witness and want the document dated. Some want their statutory form used substantially as written. Check your state's row in the table above.

Step 5: Attach Any Additional Health Care Directives

If you have another health care directive you want to create, do it at the same time. You can add directives later, but it is easier to do them all at once.

If you add a directive later, reread your medical power of attorney to make sure the two documents do not contradict one another.

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How to Fill Out a Medical Power of Attorney

Filling out the form takes six steps: your details and your agent's, alternate agents, the powers you grant, any changes, the revocation section, and signing. Work through them in order and complete every required part. Our form already lists several powers, so you only change what you want.

Step 1: Fill Out Your Personal Information and Name Your Agent

Write your full name and current address, including state, county, street and zip code. Then add the name and address of the person you want as your agent, plus their contact details, such as a phone number and email address.

Update this section if you or your agent move.

Step 2: Name Alternate Agents if Desired

An alternate (successor) agent is your backup if your first agent is also incapacitated or cannot be reached in time. The alternate also takes over if your first agent declines to act.

You can name one person, several people, or no alternate at all. If no named agent can act, your doctors turn to whoever your state allows. That may not be the person you would choose, so naming an alternate is wise.

Step 3: Approve or Disapprove the Provisions of Your Medical Power of Attorney Form

Our form has several powers already outlined for you. You can accept all of them, or you can edit the document to remove one or more.

You can also add medical powers, but it is a good idea to consult a lawyer before you change anything.

Step 4: Add Any Necessary Modifications

If you decided on any changes, make sure they are in place before you sign the document. An incomplete form can get in the way of your care.

Step 5: Leave the Revocation Clause Blank (Until Needed)

Some forms include a revocation section.

For now, leave this section blank. If you change agents later, revoke the old document in writing, tell your old agent and your doctors, and collect the old copies.

Step 6: Sign Before the Witnesses or Notary Your State Requires and Share Copies

Sign the document the way your state requires, in front of witnesses, a notary public, or both. The rules differ by state, so check what applies where you live.

Even if your state does not require a notary, you can use one to help the document be accepted.

Give copies to the people who need them:

• Your agent and any alternate agent
• Your doctor or primary care provider
• Your lawyer, if you have one
• Your emergency contacts

Keep a copy yourself. Depending on the state, you may need to tell your attending physician about the document or place it in your medical record before your agent acts.

Other Documents to Prepare With Your Medical POA

Your medical power of attorney covers health care decisions and nothing else. These related documents handle other parts of your planning, and each is a separate document you can prepare at the same time.

• Financial power of attorney: lets someone handle your money and bills
• Living will or health care advance directive: states your wishes about treatment at the end of life
• Medical HIPAA release: lets your providers share your health information
• Last will and testament: says who receives your property after your death