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Home Personal & Family Documents Power of Attorney Medical Alabama

Free Alabama Medical Power of Attorney

Use our Medical Power of Attorney form to let someone make medical decisions for you if you become incapacitated in Alabama.

Updated January 9, 2023 | Legally reviewed by Brooke Davis

An Alabama (AL) medical power of attorney (MPOA) is a type of advance directive that lets you appoint another person (called your “agent”) to make medical decisions for you if you become incapacitated.

In Alabama, a medical power of attorney is also known as a:

  • Health Care Proxy
  • Durable Power of Attorney for Health Care

Laws: Title 22, Chapter 8A, Section 4 of the Code of Alabama governs medical powers of attorney in Alabama.

Consider completing the following forms in addition to a medical power of attorney, which can be helpful in the case of an unforeseen event:

  • Living Will: A living will is another type of advance directive often combined with an MPOA on the same form. This document defines your preferences for end-of-life treatment and serves as a guide for medical professionals and your healthcare agent.
  • Alabama (Financial) Power of Attorney: This document allows an agent to make financial decisions and transactions on your behalf if you’re incapacitated.

How to Fill in an Alabama Medical Power of Attorney

The following steps will guide you through the process of completing your Alabama medical power of attorney as required by AL Code §22-8A-4:

Step 1: Choose an agent

Your agent also called your proxy or attorney-in-fact, is the individual you choose to have power over your health care decisions if you become incapacitated.

Who should you choose as an agent?

Your agent should be someone you trust completely, as they will be making life-or-death decisions for you. The agent should be capable of making healthcare decisions on your behalf according to your wishes and in your best interest. They should also have a good understanding of your moral and religious beliefs.

Relevant Law: AL Code §22-8A-4

Who can’t be your agent?

There are a few individuals who cannot act as your agent in Alabama:

  • Anyone under the age of 18
  • Your healthcare provider
  • An employee of your health care provider unless they’re related to you by blood, adoption, or marriage.

Relevant Law: AL Code §26-1A-404

Can you have more than one agent?

Only one agent can act on your behalf at once, but Alabama law allows you to name a backup agent if the first person you designate is unavailable or unwilling to serve.

Relevant Law: AL Code §22-8A-4

Step 2: Specify what healthcare decisions your agent can make.

It’s a good idea to include clear and specific wishes regarding your care wishes and which decisions your agent can make on your behalf. The wishes you describe in your MPOA (or another advance directive) won’t apply if you’re pregnant.

Can you limit your agent’s powers?

Yes, you can restrict your agent’s decisions on your behalf. You can also include specific wishes regarding your healthcare in the document.

Suppose you don’t put any limitations on your form. In that case, your agent will have the power to make the healthcare decisions you would typically make for yourself while you’re incapacitated.

Relevant Law: AL Code §26-1A-404

What is your agent legally unable to do?

Your agent can’t authorize any of the following on your behalf:

  • Psychosurgery
  • Sterilization
  • Abortion (unless necessary to preserve your life)
  • Involuntary admission to a mental health facility
  • Involuntary mental health treatment

Your agent can’t make any decisions regarding life-sustaining treatment, artificial nutrition, or hydration if you don’t expressly authorize it in your MPOA document.

Relevant Law: AL Code §22-8A-4

When can your agent start making decisions for you?

After your doctor determines you’ve lost the ability to make decisions about your health care and gets a second opinion from another qualified physician, your agent can take over and make decisions on your behalf.

Relevant Law: AL Code §22-8A-4

Step 3: Sign the form

Your Alabama medical power of attorney becomes legally binding once you sign according to the following requirements:

Do you need a witness or notary’s signature?

Yes, two people must witness your signature and affirm that you’re of sound mind when signing. If you can’t sign, you can direct someone (aside from your witnesses) to sign for you in your presence. Alabama law doesn’t require the document to be notarized.

Relevant Law: AL Code §22-8A-4

Who can’t be a witness?

The witnesses can’t be:

  • Anyone related to you by blood, marriage
  • Anyone entitled to any portion of your estate
  • The person paying for your medical care
  • Anyone under the age of 19

Relevant Law: AL Code §22-8A-4

How long is your Alabama medical power of attorney adequate?

Unless you include an expiration date, your Alabama MPOA will be effective indefinitely until you revoke it.

Relevant Law: AL Code §26-1A-404

Free Alabama Medical Power of Attorney Form (PDF & Word)

Download an unfilled Alabama MPOA template below to serve as a guide for creating your medical power of attorney form. 

State of Alabama
POWER OF ATTORNEY FOR MY HEALTH CARE

A Simple Health Care Advance Directive

This form combines the many different state legal requirements into a “universal” legal form that is intended to meet the basic requirements in most states. This form has space so you can add any special instructions or limitations you wish to include. But remember, this form is a basic Health Care Power of Attorney. It is not meant for a lengthy statement of your wishes and preferences. Remember, you should discuss your wishes and priorities directly with your agent and with others who are close to you.

INFORMATION ABOUT THE PRINCIPAL

Principal’s Full Name
Principal’s Street Address
City State Zip Code
Principal’s Daytime Phone Principal’s Other Phone
Principal’s Birthday Principal’s Email Address

WHO WILL BE YOUR HEALTH CARE AGENT?

Agent’s Full Name
Agent’s Street Address
City State Zip Code
Agent’s Daytime Phone Agent’s Other Phone
Agent’s Email Address

WHO WILL BE YOUR BACK-UP AGENT(S)?

If my first agent is unwilling or unable to act for any reason, then my next choice is:

Back-Up Agent’s Full Name
Back-Up Agent’s Street Address
City State Zip Code
Back-Up Agent’s Daytime Phone Back-Up Agent’s Other Phone
Back-Up Agent’s Email Address

If the first two agents are not willing or able to act for any reason, then my next choice is:

Second Back-Up Agent’s Full Name
Second Back-Up Agent’s Street Address
City State Zip Code
Second Back-Up Agent’s Daytime Phone Second Back-Up Agent’s Other Phone
Second Back-Up Agent’s Email Address

WHAT WILL YOUR AGENT’S POWERS BE?

My agent knows my goals and wishes based on our conversations and on any other guidance I may have written. My agent has full authority to make decisions for me about my health care according to my goals and wishes. If the choice I would make is unclear, then my agent will decide based on what he or she believes to be in my best interests. My agent’s authority to interpret my wishes is intended to be as broad as possible, and includes the following authority: (Check all that apply)

☐ 1. To agree to, refuse, or withdraw consent to any type of medical care, treatment, surgical procedures, tests, or medications. This includes decisions about using mechanical or other procedures that affect any bodily function, such as artificial respiration, artificially supplied nutrition and hydration (that is, tube feeding), cardiopulmonary resuscitation, or other forms of medical support, even if deciding to stop or withhold treatment could or would result in my death. ______ (Principal’s initials)

☐ 2. To have access to medical records and information to the same extent that I am entitled to, including the right to disclose health information to others.

☐ 3. To authorize my admission to or discharge (even against medical advice) from any hospital, nursing home, residential care, assisted-living or similar facility or service.

☐ 4. To contract for any health care-related service or facility for me, or apply for public or private health care benefits, with the understanding that my agent is not personally financially responsible for those contracts.

☐ 5. To hire and fire medical, social service, and other support personnel who are responsible for my care.

☐ 6. To authorize my participation in medical research related to my medical condition.

☐ 7. To agree to or refuse using any medication or procedure intended to relieve pain or discomfort, even though that use may lead to physical damage or dependence or hasten (but not intentionally cause) my death.

☐ 8. To decide about organ and tissue donations, autopsy, and the disposition of my remains as the law permits.

☐ 9. To take any other action necessary to do what I authorize here, including signing waivers or other documents, pursuing any dispute resolution process, or taking legal action in my name.

DO YOU HAVE SPECIAL INSTRUCTIONS OR LIMITATIONS FOR YOUR AGENT?

___________________________________________________________________________________

WHEN WILL THIS POWER BE EFFECTIVE?

This Power of Attorney for My Health Care will become effective during any time in which, in the opinion of my agent and attending physician, I am unable to make or communicate a choice about a particular health care decision.

OTHER PROVISIONS

  1. Health care providers can rely on my agent. No one who relies in good faith on any representations by my agent or back-up agent will be liable to me, my estate, my heirs or assigns, for recognizing the agent’s authority.
  1. I cancel any previous power of attorney for health care that I may have signed.
  1. I intend this power of attorney to be universal; it is valid in any jurisdiction in which it is presented.
  1. I intend that copies of this document are as effective as the original.
  1. My agent will not be entitled to compensation for services performed under this power of attorney, but he or she will be entitled to reimbursement for all reasonable expenses that result from carrying out any provision of this power of attorney.

SIGNATURE

I understand the contents of this document and the effect of granting powers to my agent.

Principal’s Signature
Principal’s Name
Date

A STATEMENT BY YOUR WITNESSES

I declare that I personally know you ─ the person who signed this document ─ or I have adequate proof of your identity, and that you signed or acknowledged this Power of Attorney for My Health Care in front of me, and that you appear to be of sound mind and under no duress, fraud, or undue influence.

I am an adult and am NOT any of the following:

  1. Appointed as your agent or back-up agent.
  2. Related to you by blood, marriage, domestic partnership, or adoption, nor a spouse of any such person.
  3. Your health care provider, including the owner or operator of a health, long-term care, or other residential or community care facility serving you.
  4. An employee of your health care provider.
  5. Financially responsible for your health care.
  6. An employee of your life or health insurance provider.
  7. A creditor of yours or entitled to any part of your estate under a will or codicil, trust, insurance policy, or by operation of intestate succession laws.
  8. Entitled to benefit financially in any other way after you die.

First Witness

Witness Signature Date
Witness Name
Witness Address
City State Zip Code

Second Witness

Witness Signature Date
Witness Name
Witness Address
City State Zip Code

NOTARY ACKNOWLEDGEMENT OF PRINCIPAL

State of _________________ )

) (Seal)

County of _________________ )

The foregoing instrument was acknowledged before me this _____ day of _______________, 20_____, by the undersigned, ________________________, who is personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.

_____________________________________

Signature

_____________________________________

Notary Public

My Commission Expires: ________________

NOTARY ACKNOWLEDGEMENT OF WITNESSES

State of _________________ )

) (Seal)

County of _________________ )

The foregoing instrument was acknowledged before me this _____ day of _______________, 20_____, by the undersigned witnesses, ________________________________________________, and _______________, who are personally known to me or satisfactorily proven to me to be the person whose name is subscribed to the within instrument.

_____________________________________

Signature

_____________________________________

Notary Public

My Commission Expires: ________________

PDF
Word

How to Revoke an Alabama Medical Power of Attorney

Your medical power of attorney can be revoked at any time you wish with one of the following methods:

  • Inform your agent or healthcare provider
  • Destroy the original document (rip, burn, or deface it)
  • Create a written revocation of power of attorney form
  • State your intention to revoke the MPOA in front of a witness (at least 19 years old) who will create and sign a written confirmation

Additionally, if you divorce your spouse, you were previously assigned as your MPOA agent, and their powers as the agent will be automatically revoked.

Relevant Law: AL Code §26-1A-404

Alabama medical power of attorney form

Free Alabama Medical Power of Attorney Form

Create Your Alabama Medical Power of Attorney in Minutes!

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Free Alabama Medical Power of Attorney

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