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Home Personal & Family Documents Power of Attorney Medical Pennsylvania

Free Pennsylvania Medical Power of Attorney Form

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

Updated May 15, 2022 | Legally reviewed by Susan Chai, Esq.

A Pennsylvania (PA) Medical Power of Attorney (MPOA) lets you assign someone to make medical decisions on your behalf if you can’t communicate your wishes. The person you choose, called your agent, can only make medical decisions while you’re incapacitated.

Laws: Pennsylvania Consolidated Statutes, Title 20, Chapter 54, Subchapter C provides legal guidance on creating a Medical Power of Attorney.

In addition to creating an MPOA, consider the following forms for planning for a medical emergency:

  • Living Will: A living will lets you document your medical care and treatment preferences. Medical POAs and Living Wills fall under legal documents known as advance directives.
  • PA (Financial) Power of Attorney: A financial POA lets you assign an agent to manage your affairs relating to business, finances, and other non-medical areas.

How to Fill in a Medical Power of Attorney in Pennsylvania

The following steps guide you in creating a legally valid form, as specified in 20 Pa.C.S. §5451-5465.

Step 1: Choose an agent

Your agent is a person you choose to make healthcare decisions for you if you’re too sick to communicate.

Who should you choose as an agent?

Your agent should be a trustworthy, responsible person over age 18. You should also choose an agent who knows your wishes and beliefs regarding medical care.

Relevant law: 20 Pa.C.S. §5455

Who can’t be your agent?

Unless they’re related to you (by blood, marriage, or adoption), you can’t choose the following people as agents for your medical POA:

  • Your health care or residential care provider
  • An owner, manager, or employee of your residential or medical facility

Relevant law: 20 Pa.C.S. §5455

Can you have more than one agent?

In Pennsylvania, you can choose:

  • More than one agent to make healthcare decisions for you
  • One or more successor agents to act as an alternate to your primary agent(s)

If you wish to have multiple health care agents, they will work together to make decisions about your medical care unless you indicate otherwise in your MPOA document.

Step 2: Specify what healthcare decisions your agent can make

Consider what powers you want to give your agent as you fill out the form.

Can you limit your agent’s powers?

You can include specific limitations on the agent’s powers in the medical POA document. You can also describe your intentions for your care in the document so your agent and doctors can act accordingly.

If you don’t state otherwise in your medical POA, your agent can make any decision you would usually about your health, including:

  • Withholding or withdrawing life-sustaining care
  • Donating your organs if you die
  • Deciding where you receive treatment
  • Accessing and disclosing your medical records to make informed decisions

If you wish, you can name a person (like a relative or physician) your agent should consult with on health care decisions if they’re unsure how to proceed.

Relevant law: 20 Pa.C.S. §5456

What is your agent legally unable to do?

Pennsylvania law states that if you’re pregnant, your agent can’t withdraw life-sustaining treatment unless your doctor determines the fetus isn’t viable or would cause you intractable pain or harm.

Although PA laws don’t include many limitations on health care agents’ powers, your agent is required to take the following steps when deciding on your behalf:

  1. Gather information on your prognosis
  2. Consult with health care professionals
  3. Make decisions based on your instructions
  4. Make decisions based on your values and beliefs (in the absence of instructions)
  5. Make decisions in your best interests and consider the preservation of life, relief from suffering, and the preservation or restoration of functioning.

Healthcare providers in PA are also required to ensure health care agents follow these steps when deciding on your behalf.

Relevant law: 20 Pa.C.S. §5429

When can your agent start making decisions for you?

In Pennsylvania, your health care agent’s powers take effect when:

  • someone gives a copy to the attending physician and,
  • a doctor determines that you are medically incompetent

If you regain the ability to make your own healthcare decisions, your agent will lose their powers.

Relevant law: 20 Pa.C.S. §5454

Step 3: Sign the form

To make your Healthcare POA legal, you must sign and date the document according to PA requirements. If you’re unable to sign, you can direct someone other than your doctor or agent to sign for you in your presence.

Relevant law: 20 Pa.C.S. §5452

Do you need notary or witness signatures?

Yes, you must have people witness your signature to validate the MPOA. You may, but aren’t required to, have the document notarized.

Who can be a witness?

Witnesses cannot be:

  • Anyone under the age of 18
  • Someone who signed the document on your behalf

PA laws also note that your witnesses shouldn’t be your heirs, creditors, or employees of your healthcare providers, as there could be a potential conflict of interest.

Relevant law: 20 Pa.C.S. §5452 and 20 Pa.C.S. §5471

How long is your Medical Power of Attorney effective in Pennsylvania?

Once signed, your Medical Power of Attorney has no expiration date unless you include one in the document.

If you don’t specify a date, the form remains in effect until it’s revoked by:

  • You (the principal)
  • The court
  • A court-appointed guardian

Relevant law: 20 Pa.C.S. §5454

How to Revoke a Pennsylvania Medical Power of Attorney

You can revoke the Power of Attorney for your medical needs. To do so, take one of the following steps:

  • Write and execute a Revocation of Power of Attorney
  • Tell your doctor or healthcare provider that you wish to revoke the legal form.

Whichever method you use to revoke, it’s essential to inform your agent about the revocation.

Relevant law: 20 Pa.C.S. §5459

Free Pennsylvania Medical Power of Attorney Form

Create Your Pennsylvania Medical Power of Attorney in Minutes!

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