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Home Personal & Family Documents Power of Attorney Medical Louisiana

Free Louisiana Medical Power of Attorney Form

Use our Louisiana Medical Power of Attorney form to let someone make medical decisions for you if you become unable to do so.

Updated April 22, 2022 | Legally reviewed by Susan Chai, Esq.

A Louisiana medical power attorney (MPOA) lets you give another person, called your agent, power over your health care decisions should you become incapacitated. Your agent must carry out your healthcare wishes according to the instructions you leave in the form.

Laws: Title 40, Section 1151 of the Louisiana Revised Statutes (RS §40:1151) governs powers of attorney for healthcare decisions.

To be completely covered in case of an unforeseen event, you may want to complete these documents along with your medical power of attorney:

  • Living Will: A living will is another type of advance directive that lets you describe your wishes for treatment and care at the end of life in case you become incapacitated, so your doctor and agent know how to act.
  • Louisiana (Financial) Power of Attorney: A financial power of attorney lets you give an agent of your choosing the right to manage some or all of your finances.

How to Fill in a Medical Power of Attorney in Louisiana

Learn how to fill in your medical power of attorney in Louisiana and make sure you meet all requirements outlined in RS §40:1151.

Download a Louisiana Medical Power of Attorney Form

Use the following template to guide you as you create your own LA medical power of attorney form:

Download: PDF | Word

Step 1: Choose an agent

The agent is the person you choose to take over your healthcare decisions and act in your best interest after you become incapacitated.

Who should you choose as an agent?

Choose an agent you trust who understands your religious and moral beliefs. If you become incapacitated, your agent must decide what medical treatments and decisions they based on their knowledge of your wishes, so it’s best if they know you well.

Who can’t be your agent?

You can choose any person you trust to be your agent, but it’s best if they aren’t directly involved with your medical care or have a potential conflict of interest (like someone who will inherit from you).

Relevant law: RS § 40:1151.2

Can you have more than one agent?

You can designate an alternate agent to step in if the original agent is unable or unwilling to act. The alternate agent should have the same qualifications as your primary agent.

Relevant law: RS § 40:1151.2

Step 2: Specify what healthcare decisions your agent can make

It’s important to specify what decisions you’re comfortable with your agent making if you become incapacitated without limiting their ability to make the right decision based on the situation.

Can you limit your agent’s powers?

Yes, you can limit your agent’s power by writing instructions into the medical power of attorney document, for example, “I do not want my organs donated after my death.” If you don’t limit your agent’s power they’ll be able to make most decisions you would normally make about your health care.

Relevant law: RS § 40:1151.2

What is your agent legally unable to do?

Your agent is never allowed to change your will or transfer the medical power of attorney to someone else unless it is expressly stated in the document. They’re also legally obligated to act in your best interest and make decisions based on what they think you would want.

Relevant law: RS § 40:1151.2

When can your agent start making decisions for you?

Your agent can only make decisions for you after your doctor determines that you’re incapable of making medical decisions for yourself.

Relevant law: RS § 40:1151.2

Step 3: Sign the form

Sign and date your form according to the following Louisiana requirements. If you’re unable to sign, you can instruct another person to sign for you in your presence.

Do you need a witness or notary signatures?

You and two competent witnesses must sign the MPOA form for it to become legally binding.

Relevant law: RS § 40:1151.2

Who can’t be a witness?

You can choose anyone you know to be a witness, as long as they can confirm your identity and willingness to sign the medical power of attorney.

Relevant law: RS § 40:1151.2

How long is your Louisiana medical power of attorney effective?

Unless you include a start date, your medical power of attorney will remain effective until you revoke it or until your death.

During this time, your agent’s powers will only go into effect if you become incapacitated.

Relevant law: RS § 40:1151.2

How to Revoke a Louisiana Medical Power of Attorney

You can revoke your Louisiana medical power of attorney at any time, even after incapacitation. Use any of the following methods to revoke:

  • Deface, burn, tear, or otherwise destroy the original document or direct someone to do so in your presence
  • Tell your doctor you want to revoke your MPOA
  • Create a written revocation of power of attorney form
  • File a declaration with the secretary of state’s office (if your MPOA was previously registered)

Relevant law: RS §40:1151.3

Related Will & Estate Planning Documents

  • Louisiana Power of Attorney: A Louisiana Power of Attorney is a written document that officially recognizes a legally binding relationship between two parties -- a Principal and an...
  • Louisiana Durable Power of Attorney: Free durable power of attorney form for Louisiana (LA) to grant someone the legal authority to act and make decisions on behalf of another person.
  • DNR Form: States that you refuse resuscitation via CPR in the event that your heart stops beating or you stop breathing.
Louisiana medical power of attorney form

Free Louisiana Medical Power of Attorney

Create Your Louisiana Medical Power of Attorney in Minutes!

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