Free Medical Power of Attorney Form

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.

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.

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 

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.

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. 

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:

There are a variety of other documents related to Medical POA's that might be relevant to your needs, depending on your specific situation. Our expert legal document making tools can help you create many of these helpful forms in no time at all:

• Power of Attorney: Used to appoint another person to make a variety of different decisions on your behalf, often of a financial nature. 

• Durable Power of Attorney: Enables an individual to legally appoint one or more persons to manage some or all their financial affairs. 

• Living Will: Clearly states someone’s preferences in regard to future medical treatments and health care decisions. 

• Last Will and Testament: Outlines a person’s final wishes in terms of how their assets will be distributed after their death.

• Advance Directive: Used to set a medical treatment plan in certain circumstances.

• Power of Attorney Revocation: Annuls any powers given to an agent, through a Power of Attorney.