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(MPOA) Medical Power Of Attorney Form PDF Free Download
Medical Power Of Attorney
A medical power of attorney (MPOA) is an official document that designates an agent or attorney-in-fact to make healthcare decisions on the principal’s behalf.
A dispute on whether the principal can make their own decisions will only go into effect after a licensed physician has deemed the principal incapacitated.
It’s recommended for anyone making a medical power of attorney to also create a living will, which allows them to outline their treatment preferences for an agent to follow.
IMPORTANT INFORMATION
IT IS IMPORTANT THAT YOU REVIEW THE FOLLOWING INFORMATION BEFORE YOU SIGN THIS DOCUMENT.
READ THE INFORMATION CAREFULLY AND SEEK GUIDANCE FROM A HEALTHCARE PROFESSIONAL OR ATTORNEY IF YOU DO NOT UNDERSTAND ANY OF THE TERMS.
By signing this document, you are giving authority to the person you are designating as your agent to make medical decisions on your behalf.
Medical decisions can include any medical service, treatment, medical procedure, diagnosis or treat both mental and physical conditions.
Your agent will be able to act with the same authority you would have if you were able to act for yourself and will have the authority to consent, or refuse to consent to medical treatment including decisions about withdrawing or withholding life-sustaining treatment.
It is, therefore, important that you know and trust your agent and that your agent is aware of your preferences for health care treatment.
Even after you sign this document, you will still be able to make your healthcare decisions assuming you are still considered mentally competent.
Your agent cannot act on your behalf until your physician has determined that you are no longer physically or mentally able to make medical decisions.
The person you choose as your agent must be at least eighteen years old and someone that you trust with your health care.
Your agent is not liable for any decisions they make on your behalf, as long as those decisions were made in good faith.
You should make sure that you have chosen an agent who wants to take on the role of agent.
Discuss your medical preferences with your agent so they are aware of your wishes.
Review this document with your agent so they are aware of their role.
You also may choose a backup agent in case your other agent is unavailable to act. Your backup agent should also be over 18 and aware of your preferences.
You may revoke this document at any time while you are still competent to do so.
You may revoke it by telling your medical provider and your agent that you are revoking the document or you may provide them with a written revocation.
If you execute another power of attorney later, that will have the effect of revoking this one.
In order for this document to be valid, it must be signed in the presence of a notary or two witnesses.
If you choose to have two witnesses sign, they must be at least 18, competent and independent and not your agent or related to your agent.
Statutory Forms
| STATE | STATUTORY FORM |
|---|---|
| Alabama | Advance Directive for Health Care |
| Alaska | Advance Health Care Directive |
| Arizona | Health Care Power of Attorney |
| Arkansas | Durable Power of Attorney for Health Care |
| California | Advance Health Care Directive |
| Colorado | Medical Durable Power of Attorney |
| Connecticut | Appointment of Health Care Representative |
| Delaware | Advance Health Care Directive |
| Florida | Designation of Health Care Surrogate |
| Georgia | Advance Directive for Health Care |
| Hawaii | Advance Health Care Directive Form |
| Idaho | Living Will and Durable Power of Attorney for Health Care |
| Illinois | Durable Power of Attorney for Health Care |
| Indiana | Health Care Representative Appointment |
| Iowa | Durable Power of Attorney for Health Care Decisions |
| Kansas | Durable Power of Attorney for Healthcare Decisions |
| Kentucky | Advance Directive |
| Louisiana | Medical Power of Attorney |
| Maine | Health Care Advance Directive Form |
| Maryland | Advance Directive |
| Massachusetts | Health Care Proxy |
| Michigan | Durable Power of Attorney for Health Care |
| Minnesota | Health Care Directive |
| Mississippi | Advance Health Care Directive |
| Missouri | Durable Power of Attorney for Health Care |
| Montana | Durable Power of Attorney for Health Care |
| Nebraska | Power of Attorney for Health Care |
| Nevada | Durable Power of Attorney for Healthcare Decisions |
| New Hampshire | Advance Directive |
| New Jersey | Medical Power of Attorney (proxy) |
| New Mexico | Advance Directive for New Mexico |
| New York | Health Care Proxy |
| North Carolina | Health Care Power of Attorney |
| North Dakota | Health Care Directive |
| Ohio | Health Care Power of Attorney |
| Oklahoma | Advance Directive for Health Care |
| Oregon | Advance Directive for Health Care |
| Pennsylvania | Durable Health Care Power of Attorney |
| Rhode Island | Durable Power of Attorney for Healthcare |
| South Carolina | Health Care Power of Attorney |
| South Dakota | Durable Power of Attorney for Health Care |
| Tennessee | Advance Directive for Health Care |
| Texas | Durable Power of Attorney for Health Care |
| Utah | Advance Health Care Directive |
| Vermont | Advance Directive for Health Care |
| Virginia | Advance Medical Directive |
| Washington | Durable Power of Attorney for Health Care |
| West Virginia | Medical Power of Attorney |
| Wisconsin | Power of Attorney for Health Care |
| Wyoming | Advance Health Care Directive |
| Author | – |
| Language | English |
| No. of Pages | 5 |
| PDF Size | 2 MB |
| Category | Form |
| Source/Credits | eforms.com |
(MPOA) Medical Power Of Attorney Form PDF Free Download