Medical Power of Attorney (MPOA) Form

A medical power of attorney (MPOA) gives you peace of mind by allowing you to choose someone you trust to make healthcare decisions for you if you can’t do it yourself. If you can’t express your wishes, your agent ensures your preferences are followed. Having this safety net can relieve anxiety, knowing that someone who understands what you want will be making important choices for you during difficult times.

Medical Power of Attorney – By State

Keep in mind that the requirements for an MPOA vary by state. Check the state-specific details to ensure you meet all necessary regulations and requirements.

Table of Contents

• Medical Power of Attorney - By State
• Statutory Forms - By State
• MPOA vs. Living Will
• Why Do You Need an MPOA?
• Agent Powers
• How to Get an MPOA
• Revoking an MPOA
• Medical Power of Attorney Sample
• Frequently Asked Questions

Statutory Forms – By State

Statutory forms are important because they ensure your MPOA matches state laws. Using the correct form ensures your healthcare decisions are recognized in your state and gives your chosen agent the power to act on your behalf. This also prevents delays or disputes when it matters most.

MPOA vs. Living Will

A medical power of attorney and a living will are both forms of advance directives. In many states, these two documents are often combined into a single advance directive form. While they can work together as part of advance care planning, they have two main differences:

Designation of an Agent

Unlike a medical POA, a living will doesn’t designate an agent to make healthcare decisions for you. A living will is a legal document stating your preferences regarding specific life-sustaining and end-of-life medical treatments. For example, a living will may detail your instructions regarding the following:

• Organ or tissue donation
• Life support
• Cardiopulmonary resuscitation (CPR)
• Dialysis
• Surgical procedures
• Palliative care
• Other medical treatments

Applicable Scenarios

A living will applies if you’re terminally ill, unconscious, or in an end-stage condition. It doesn’t apply to temporary incapacity with a high chance of recovery.

A medical power of attorney can allow someone to make decisions on your behalf even if you’re temporarily incapacitated but will recover.

Here are some scenarios of when a Medical POA would be applicable:

Chronic Illness Management

James, a 65-year-old man, has been diagnosed with early-stage Alzheimer’s disease. As his condition progresses, James appoints his daughter, Emily, as his agent through a Medical POA. This allows Emily to make decisions about his treatment, manage his medication, and coordinate his care as his condition evolves.

Surgery and Recovery

For example, Linda is scheduled to undergo a major surgery that carries significant risks. She designates her husband, Mark, as her agent through a Medical POA. If Linda becomes unable to make decisions during her recovery, Mark will have the legal authority to make critical healthcare decisions on her behalf, such as approving additional procedures or making end-of-life choices, if necessary.

Long-Distance Caregiving

For example, Sarah lives in New York, but her elderly mother, Margaret, resides in Florida. To ensure that she can make healthcare decisions if her mother becomes incapacitated, they create a Medical POA giving Sarah the authority to make decisions remotely and ensure that her mother’s medical preferences are respected, even from a distance.

Why Do You Need an MPOA?

Regardless of their current health, any adult can benefit from having a medical power of attorney in case they become incapacitated and need someone to make decisions to aid their recovery or assist with end-of-life decisions.

• Address health concerns: Appoint someone to manage care after a serious diagnosis.
• Plan for procedures: Make sure someone can act if unexpected issues arise during medical treatment.
• Reduce family stress: Give loved ones clarity on your healthcare decisions.

Agent Powers

Examples of powers you can grant your agent:

• Approve or decline medical care, treatments, and medications.
• Access your medical records
• Approve admission to or discharge from healthcare facilities
• Authorize participation in medical research
• Arrange healthcare services or facilities without financial responsibility
• Manage or dismiss care personnel involved in your treatment

Agent Limitations

While agents have broad authority under an MPOA, their powers are not without limits. Understanding these boundaries ensures your healthcare decisions are respected and legally protected.

Your MPOA agent:

• cannot make financial decisions
• must follow your preferences
• is restricted by state laws
• must avoid conflicts of interest
• is bound by ethical standards

How to Get an MPOA

Creating a medical power of attorney lets you take control of your healthcare decisions. Follow these steps to ensure your wishes are clear and legally protected:

1. Choose Your Agent

Select someone you trust who understands your wishes and is emotionally capable of making tough decisions. Ensure they meet legal requirements, such as being at least 18 and mentally competent.

2. Define Authority

Decide the specific medical decisions your agent can make, such as approving treatments, managing care, or consenting to procedures.

3. Attach Advance Directives

Include other documents, like a living will or DNR, to give detailed instructions about your healthcare preferences.

4. Sign and Share

Follow your state’s signing requirements, such as witnesses or notarization. Distribute copies to your agent, physician, and loved ones.

Revoking an MPOA

If your situation changes, you can revoke your MPOA and update your choices. Follow these steps and ensure everyone involved is informed.

1. Complete a Revocation Form

Fill out a revocation of power of attorney form for your jurisdiction.

2. Meet Signing Requirements

Follow your state’s requirements for witnesses or notarization to validate the revocation.

3. Distribute the Revocation

Provide copies of the revocation form to your former agent, healthcare providers, and anyone else with the original MPOA.

4. Create a New MPOA (optional)

Appoint a new agent or update your preferences with a new medical power of attorney form.

Medical Power of Attorney Sample

Download a medical power of attorney form below as a PDF or Word file to understand what it looks like. Ensure you use a state-specific MPOA template.

Although the document above is a good example, you should use a medical power of attorney form specific to your state to ensure it’s valid when your agent needs to make healthcare decisions for you.

Frequently Asked Questions