Medical power of attorney
Name someone to make health-care decisions for you if you cannot, and say what matters to you.
Name someone to make medical decisions if you can't.
- Personal / Legal document
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Key features
An agent and an alternate
Identification boxes for each, with the alternate stepping in if the agent cannot or will not act or cannot be reached.
When the agent may act
A blank to say whether authority begins only when you cannot decide for yourself or from the date you sign. While you can decide, the form says the decisions remain yours.
What the agent may decide
Consent to, refusal of or withdrawal from care, treatment, tests, medication and surgery; choosing doctors and hospitals; moving between places of care; and comfort care.
Your limits and your values
Separate blanks for decisions the agent may not make, and for what matters most to you, in your own words.
Medical information and people to tell
The agent may be given your medical information, and there is a list of people to be told if decisions are being made for you.
About this document
A medical power of attorney appoints an agent, and an alternate, to make decisions about your health care when you cannot make or communicate them yourself. It also lets you write down what matters most to you, limits on what the agent may decide and who should be told.
This is a blank form to complete by hand. The rules on who may be an agent, how the document must be signed, witnessed or notarized, and when it takes effect differ widely between states, and many states publish their own form. Check your state's rules, or ask a lawyer, before relying on this one.
Is this document right for you?
Useful when
- You want a named person, not the default family member, to speak for you medically
- You are facing surgery, treatment or a diagnosis
- You want your agent to know your values as well as your instructions
Commonly used by
- Adults planning ahead for illness
- People with a serious diagnosis
- Those who live apart from their closest relatives
Not sure? about your situation first.
Alternatives
These are separate documents, for different jobs.
- Healthcare directiveSet out your healthcare wishes and who can speak for you.View document
- Living willRecord your wishes about medical treatment in advance.View document
- Power of attorneyName someone you trust to handle your finances if you can't.View document
- Personal care profileShare your routines and care preferences with those caring for you.View document
When to use this
- Before a planned operation
- When you want a friend, not a relative, to decide for you
- When you have also written a directive and want an agent to read it with
What happens next
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More in Power of Attorney
- Power of attorneyName someone you trust to handle your finances if you can't.View document
- Revocation of power of attorneyFormally cancel a power of attorney you've given.View document
- Power of attorney for childLet another adult act for your child while you're away.View document
- Authorization lettersGive someone permission to act for you on a specific matter.View document
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Questions
About the medical power of attorney
Many states have their own required or recommended wording, and some have rules about witnesses or notaries. This form does not know your state. Check, or use the lawyer-prepared option on this page.
Still have a question? .