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Free Medical Power of Attorney Form

Create and download a free customized Medical Power of Attorney form for your individual medical affairs and necessities today.

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Last Update July 22nd, 2022

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Medical Power of Attorney
What's the difference?
  • Medical Power of Attorney: it gives an agent the authority to make medical decisions for you if you are incapacitated.

  • Living Will: it allows an individual to state preferences for medical treatment, focusing on end-of-life decisions.

  • Advance Directive: it includes the instructions collected in a Living Will and in a Medical Power of Attorney.

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What Is a Medical Power of Attorney (MPOA)

A Medical Power of Attorney (POA) is a form of Durable POA that allows you to appoint an individual (often known as your Agent or Attorney-in-Fact) to make important health care decisions for you if you cannot.

This type of document is also known as a: 

  • Power of Attorney for Health Care

  • Advance Healthcare Directive

  • Medical Power of Attorney Directive

  • Durable Power of Attorney for Health Care

  • Medical POA (MPOA)

This differs greatly from a General Power of Attorney, which is more commonly used by the public and can only appoint an Agent to manage your financial decision-making. Instead, this type of medical-legal document can be put in place to provide for your healthcare necessities in the event of incapacitation.

Medical POA vs Living Will

A Medical Power of Attorney may seem similar to a Living Will to some. However, there are some significant differences between the two legal documents. In fact, both can be used to complement each other.

Both these forms are known as Advanced Directive documents and allow you to carefully plan for advanced age, future illness, or treatment following a major injury.

Living Wills, on one hand, explicitly details your medical treatment preferences. They might be used to approve emergency procedures that will ensure your recovery or to withhold further treatment if your situation is grave and unlikely to improve.

Medical Power of Attorneys, on the other hand, focuses more on the naming of a representative for a patient. It allows you, the Principal, to name a person you trust to give medical consent to treatment when you cannot yourself. Normally, this will only come into effect when a doctor deems you incapable of being able to make your own decisions.

How to Get a Medical Power of Attorney

The process of getting a Medical Power of Attorney is quite similar to other POAs. You can either complete a Healthcare POA form yourself, or you can seek out an Attorney at Law to help you draft the document.

It is possible to find free blank Medical Power of Attorney forms both online and from your healthcare provider. These will give you all you need to name and authorize an Agent to act on your behalf for your medical needs.

Below are the key steps you need to follow to create your own MPOA form.

Choose an Agent 

As a Medical POA can grant significantly far-reaching powers, your Attorney-in-Fact needs to be carefully chosen. It doesn’t necessarily have to be a member of your family, but it should always be someone you trust.

You should also speak at length with your prospective Agent to be sure that they consent to the responsibility you’re giving them. Additionally, you must give a very clear picture of what your wishes are regarding your future medical treatment.

There’s also the option to choose a successor or 2nd Agent in case the primary Agent is not able to complete their duties. If desired, you can even set up a compensation plan for the Agent. 

Define Agent’s Authority 

The next stage of creating your document is to clearly define the powers that you will give to your chosen Agent. 

Consider carefully your personal health care situation, and what kind of decisions you will need the Agent to take, either in the short or long term. It’s also important to consider when you want to empower the Agent to act. You can also set a triggering event, such as when a doctor deems you unable to give consent for yourself or start a date for their authority.

You should define the following Agent powers in your POA:

  • End of life decisions

  • Hospitalization

  • Medical treatment

  • Psychiatric treatment 

  • Nursing home care

  • Homestay care

  • Organ donations

Add a Living Will 

Although not mandatory, adding a living will to your MPOA is highly recommended by many legal and health care experts. This will help you outline your end-of-life treatment selections, in addition to having someone to speak on your behalf. 

By using a living will, you will be able to define what you want to happen in case you were to end up in an incapacitated state without a chance for a cure. It also allows you to choose post-death options such as organ donation. 

Sign According to State Requirements

Once your form is completed, it will then need to be signed by both the Principal and the Agent according to the respective state signing laws. In most states, the form will have to be signed in the presence of two witnesses and/or a notary public. The Principal must also be of sound mind and be able to sign the document out of their own free will. 

After it has been finalized, you should then file the form with your healthcare providers so that they have the document on record. This will speed up its use in the future.

Be aware, there are five states which require Principals to provide detailed instructions on their Healthcare POA. Standard forms just appointing an Agent will not work in these locations. These states are:

  • Indiana

  • New Hampshire

  • Ohio

  • Texas

  • Wisconsin 

How to Write a Medical Power of Attorney

In order to complete a Medical Power of Attorney document, there are various steps you need to follow: 

  1. Select Create Document at the top of this page

  2. Enter the name of both the Principal and the Agent, as well as their address and contact details

  3. Specify on what date the POA will come into effect

  4. Choose the powers and responsibilities you wish to grant the Agent

  5. Download and print your completed forms 

  6. Sign and date the documents

Depending on your state, you will usually need a notary and one or more witnesses to sign the document as well. Scroll down to our MPOA statutory forms and signing requirements section to find out the regulations for your state.

Medical Power of Attorney Sample

Below, you’ll find an example of what a completed Medical Power of Attorney looks like. This is a standard sample document that cannot be used in all states nor in all contexts. To create your own customized document, use LawDistrict’s POA template builder. 

MPOA Statutory Forms and Signing Requirements

The signing requirements for Medical Power of Attorney documents vary from state to state. However, almost all states require at least one witness or notary public to also sign the document. 

Keep in mind that a witness cannot be someone that is related to the Principal or Agent. They also cannot be someone that is a beneficiary in the Principal’s last will and testament. In the event that a notary is necessary, the same notary may not count as a witness to the singing. 

Below are the MPOA signing requirements and the related statutory forms for each U.S. state:

State Statutory Forms Signing Requirements Laws
Alabama Advance Directive for Health Care Two (2) Witnesses § 22-8A-4(c)(4)
Alaska Advance Health Care Directive Notary Public or Two (2) Witnesses AS 13.52.010, AS 13.52.010(b)
Arizona Health Care Power of Attorney Notary Public or One (1) Witness § 36-3224,

§ 36-3221(A)(3)

Arkansas Durable Power of Attorney for Health Care Notary Public or Two (2) Witnesses § 20-6-103,

§ 20-6-103(c)

California Advance Health Care Directive Notary Public or Two (2) Witnesses PROB § 4701,

§ 4701(e)

Colorado Medical Durable Power of Attorney No law (Notary Public recommended) § 15-14-506
Connecticut Appointment of Health Care Representative Two (2) Witnesses Sec. 19a-575a, Sec. 19a-575a
Delaware Advance Health Care Directive Two (2) Witnesses § 2505,

§ 2503(b)(1)(d)

Florida Designation of Health Care Surrogate Two (2) Witnesses § 765.202(1)
Georgia Advance Directive for Health Care Two (2) Witnesses § 31-32-4,

§ 31-32-5

Hawaii Advance Health Care Directive Form Notary Public and Two (2) Witnesses § 327E-16,

§ 327E-3(1)

Idaho Living Will and Durable Power of Attorney for Health Care No law (Notary Public recommended) § 39-4510
Illinois Durable Power of Attorney for Health Care One (1) Witness 755 ILCS 45/4-5.1, 755 ILCS 35/3(b)
Indiana Health Care Representative Appointment One (1) Witness 755 ILCS 45/Art. IV,

§ 16-36-1-7(b)(3)

Iowa Durable Power of Attorney for Health Care Decisions Notary Public or Two (2) Witnesses § 144B.5,

§ 144B.3(b)

Kansas Durable Power of Attorney for Healthcare Decisions Notary Public and Two (2) Witnesses § 58-632
Kentucky Advance Directive Notary Public or Two (2) Witnesses § 311.629,

§ 311.625(2)

Louisiana Medical Power of Attorney Two (2) Witnesses RS 28:223,

§ 224 (A)

Maine Health Care Advance Directive Form Two (2) Witnesses § 5-805,

§ 5-803(2)

Maryland Advance Directive Two (2) Witnesses § 5–603
Massachusetts Health Care Proxy Two (2) Witnesses § 201D-2
Michigan Durable Power of Attorney for Health Care Two (2) Witnesses § 700.5501(b),

§ 700.5506(4)

Minnesota Health Care Directive Notary Public or Two (2) Witnesses § 145C.16,

§ 145C.03(5)

Mississippi Advance Health Care Directive Notary Public or Two (2) Witnesses § 41-41-209,

§ 41-41-205(2)

Missouri Durable Power of Attorney for Health Care Notary Public § 404.822,

§ 404.705(3)

Montana Durable Power of Attorney for Health Care Two (2) Witnesses § 53-21-1304,

§ 50-9-103

Nebraska Power of Attorney for Health Care Notary Public or Two (2) Witnesses § 30-3404,

§ 30-3404(5)

Nevada Durable Power of Attorney for Healthcare Decisions Notary Public or Two (2) Witnesses NRS 162A.790,

NRS 162A.860

New Hampshire Advance Directive Notary Public or Two (2) Witnesses Section 137-J:20,

§ 137-J:14

New Jersey Medical Power of Attorney (proxy) Notary Public or Two (2) Witnesses § 26:2H-56, § 26:2H-57
New Mexico Advance Directive for New Mexico Two (2) Witnesses § 24-7A-4
New York Health Care Proxy Two (2) Witnesses PBH § 2981,

PBH § 2981(2)

North Carolina Health Care Power of Attorney Notary Public and Two (2) Witnesses § 90-321,

§ 32A-16A(3)

North Dakota Health Care Directive Notary Public or Two (2) Witnesses § 23-06.5-17,

§ 23-06.5-05(d)

Ohio Health Care Power of Attorney Notary Public or Two (2) Witnesses § 1337.12(1)(b), Section 1337.17
Oklahoma Advance Directive for Health Care Two (2) Witnesses § 63-3101.4, 63 O.S. § 3101.4(A)
Oregon Advance Directive for Health Care Notary Public or Two (2) Witnesses ORS 127.527,

§ 127.515(2)

Pennsylvania Durable Health Care Power of Attorney Two (2) Witnesses § 5471,

§ 5452(b)(2)

Rhode Island Durable Power of Attorney for Healthcare Notary Public or Two (2) Witnesses § 23-4.10-2,

§ 23-4.10-2(9)

South Carolina Health Care Power of Attorney Notary Public and Two (2) Witnesses § 62-5-504,

§ 62-5-517

South Dakota Durable Power of Attorney for Health Care Notary Public or Two (2) Witnesses § 59-7-2.1,

§ 34-12D-2

Tennessee Advance Directive for Health Care Notary Public or Two (2) Witnesses § 68-11-1803(b),

§ 34-6-203(a)(3)

Texas Durable Power of Attorney for Health Care Notary Public or Two (2) Witnesses § 166.161,

§ 166.154

Utah Advance Health Care Directive One (1) Witness § 75-2a-117,

§ 75-2a-107(c)

Vermont Advance Directive for Health Care Two (2) Witnesses 18 V.S.A. § 9703,

§ 9703(b)

Virginia Advance Medical Directive Two (2) Witnesses § 54.1-2983,

§ 54.1-2984

Washington Durable Power of Attorney for Health Care Notary Public or Two (2) Witnesses § 11.125.100,

§ 70.122.030

West Virginia Medical Power of Attorney Notary Public and Two (2) Witnesses § 16-30-4(a),

§ 16-30-4

Wisconsin Power of Attorney for Health Care Two (2) Witnesses § 155.10(1)(c),

§ 155.30

Wyoming Advance Health Care Directive Notary Public or Two (2) Witnesses § 35-22-403,

§ 35-22-403(b)

FAQs About Medical Power of Attorney

If you’re still not sure if a Medical Power of Attorney is the right choice for your situation, or if you have any doubts or questions, simply browse our FAQs below.

Why Do You Need a Health Care Power of Attorney?

In the unfortunate event that an accident or condition makes it impossible for you to make your own choices, appointing a trustworthy Agent can help ensure that your wishes are fully followed.

Without a Medical Power of Attorney, difficult treatment choices might be made that go against your personal choice or preference.

How to Revoke a Medical Power of Attorney?

If your situation has changed, and you would like to revoke a previously granted Health Care Power of Attorney, you will need to make a written statement revoking the document. 

It’s also always essential to check the revocation requirements of the jurisdiction where you executed the documents. Depending on the state, you will often need to give the revocation to everyone who had a copy of the MPOA, or have your revocation witnessed and executed. 

Usually, a revocation form must include the following:

  • Your name

  • A statement that you are of sound mind

  • Your wish to revoke the MPOA

  • The date on which the original MPOA was signed

  • Name of your previous health care Agent 

In certain states, it’s possible to simply verbally proclaim your revocation to your assigned medical practitioner, sign a new medical power of attorney (and send it to everyone who had the old document), or simply destroy the MPOA. As mentioned above, make sure to check your specific state’s guidelines to ensure your revocation is properly carried out.

How to Choose a Health Care POA Agent?

When choosing a Health Care or Medical POA Agent, it’s crucial to select someone whose judgment you wholeheartedly trust. You also need to be confident that this person can properly fill the role and make sound decisions in your best interest. 

Your Agent should also be able to be assertive in terms of ensuring your wishes are fulfilled, as they may have to carry out your will against the wishes of other family members or friends. They’ll also need to be capable of talking to and asking questions of medical providers, as well as staying calm in moments of crisis. 

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