A New Hampshire (NH) medical power of attorney form lets you assign a trusted adult to make health care decisions for you, if and when you cannot make your own. The individual you pick, known as the agent, will handle most medical decisions and is legally obliged to act in your best interests.
This document can also be referred to as a:
- New Hampshire Durable Power of Attorney for Health Care
- New Hampshire Health Care Proxy
Laws: Chapter 137-J of the New Hampshire Revised Statutes govern the creation, scope, and revocation of health care agents.
In addition to your medical power of attorney form, the following documents can provide a clear plan of action in uncertain circumstances:
- Living Will: A living will records your wishes regarding life-sustaining treatment when you cannot communicate them yourself.
- New Hampshire (Financial) Power of Attorney: This durable financial power of attorney allows you to designate an agent to handle decisions regarding your finances and properties.
How to Fill in a Medical Power of Attorney in New Hampshire
Here are the steps to fill out your medical power of attorney form per the guidelines provided by the NH Revised Statutes 137-J:
Step 1: Choose an agent
Who should you choose as an agent?
You should choose an adult who is at least 18 years of age. Pick an individual you can trust to make major medical decisions in your best interest while keeping your ethics and beliefs regarding health care in mind.
Relevant law: Section 137-J:5
Who can’t be your agent?
The following cannot be your agent:
- Your health care or residential care provider
- An employee of the health care provider who is not related to you
If you choose your health care provider as an agent, they must choose between being your health care provider and your agent.
Relevant law: Section 137-J:8
Can you have more than one agent?
Yes, you can name multiple agents on your medical power of attorney form. Your agents will have authority based on the order that their names are listed in the form. So, the person you list second will be your agent if the first-listed agent cannot fulfill their duties.
Relevant law: Section 137-J:18
Step 2: Specify what health care decisions your agent can make
Can you limit your agent’s powers?
Yes. You can limit your agent’s powers by noting down specific instructions regarding life-sustaining treatment, medically-administered nutrition, and hydration, Do Not Resuscitate (DNR) order, and more in your medical power of attorney form.
Relevant law: Section 137-J:5
What is your agent legally unable to do?
Your agent cannot consent to any of the following:
- Commitment to a state institution
- Sterilization
- Termination of treatment if you are pregnant when it is deemed likely to terminate the pregnancy. However, the treatment can be withdrawn if it is harmful to you or causes prolonged severe pain which cannot be alleviated by medication.
- Psychosurgery, electro-convulsive shock therapy, or any other experimental treatment
Your agent also cannot stop you from receiving medically administered food, hydration, and other life-sustaining treatment, unless specifically stated in your advance directive.
Relevant law: Section 137-J:5
When can your agent start making decisions for you?
Your agent can make decisions for you once your attending physician certifies in writing that you are incapable of doing so. The attending physician must note down your incapacity and your agent’s information in your medical records.
Relevant law: Section 137-J:5
Step 3: Sign the form
Do you need a witness or notary signatures?
Yes. You need two or more witnesses to be present when you sign the form. If you are physically unable to sign the form, someone else can do it at your direction.
You can also choose to sign the form in the presence of a notary public or justice of the peace.
Relevant law: Section 137-J:14
Who can’t be a witness?
The following cannot act as witnesses:
- Your agent
- Your attending physician
- An individual acting under the direction of your attending physician
- Spouse or heir at law
- An individual entitled to any part of your estate via your will, trust, or any other legal notice
However, one of your witnesses can be your health care provider or the employee of a health care provider.
Relevant law: Section 137-J:14
How long is your New Hampshire medical power of attorney effective?
Your agent’s authority is revoked if you regain the capacity to make your health care decisions.
Your attending physician must certify that you can make your own medical decisions and note it in your medical records.
Relevant law: Section 137-J:5
How to Revoke a New Hampshire Medical Power of Attorney
You can revoke your medical power of attorney in New Hampshire in any of the following ways:
- Create a signed written declaration delivered to the agent or health care provider
- Orally declare the revocation in the presence of 2 witnesses. The witnesses cannot be your spouse or heir
- Act in a manner that proves your intent to revoke, such as burning or tearing the advanced directive or asking someone to do it for you
- Executing another advanced directive
If your spouse is your agent, getting a divorce, legal separation, or annulment revokes power from that agent and hands it to your alternative agent.
Any healthcare provider informed of the revocation must record the time and date of revocation in your medical records, notify the agent, the attending physician, and any staff responsible for your care.
If you inform your agent directly of their revocation, they must inform the attending physician and health care providers. The revocation takes effect once the attending physician is informed.
Relevant law: Section 137-J:15