Medical Power of Attorney Form

Table of Contents

• What Is a Medical Power of Attorney?
• What MPOA Form Do I Need for My State?
• What Can a Health Care Agent Do?
• What If I Don't Have a Medical Power of Attorney?
• How Do I Get a Medical Power of Attorney?
• How to Write a Medical Power of Attorney Form
• What Are the State Signing Requirements for an MPOA?
• Can I Change a Medical Power of Attorney Form?
• Grant Medical Decision-Making Power Today
• Medical Power of Attorney Sample
• Frequently Asked Questions

What Is a Medical Power of Attorney?

A medical power of attorney (MPOA) or durable power of attorney for health care is a legal document that lets you choose a trusted agent to make medical decisions for you. You name your agent (or “attorney-in-fact”) and specify what powers you want them to have. When the MPOA form meets the signing requirements in your state, it becomes legally binding and enforceable.

Note that this document only goes into effect when a doctor determines that you’re incapable of making decisions for yourself. This way, you retain full control over your medical decisions while you’re physically and mentally competent.

Legal Templates offers a comprehensive medical power of attorney form so you can dictate who will be in charge of your health if you can’t act for yourself. Our template contains attorney-approved language so you can get the wording just right and make it clear your agent only assumes authority when you’re incapacitated.

When Is It Needed?

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. It’s useful when you want to:

• 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 health care decisions.

Medical Power of Attorney vs. Living Will

A medical power of attorney lets you appoint a health care agent to make decisions for you when you’re incapacitated, while a living will lets you specify your wishes for end-of-life medical care, including life support, CPR, dialysis, surgical procedures, and palliative care.

Often, individuals write a living will and a medical power of attorney to cover all their bases for health care. The combination of these two end-of-life documents is called an advance directive. With both documents in place, a living will will take priority, as it dictates an individual’s specific health care wishes. However, a medical power of attorney can be a good supplementary document in case a patient needs care decisions made that they didn’t specify in their living will.

What MPOA Form Do I Need for My State?

Depending on where you live, your MPOA may need to contain specific information and follow certain guidelines. For example, some states have stricter signing requirements or guidelines for who can be a health care agent. Here at Legal Templates, we offer state-specific medical power of attorney forms so you can create one that will be enforceable in your jurisdiction.

What Can a Health Care Agent Do?

Your agent’s authority lies in your hands, so you can decide what they can and cannot do. Depending on your preferences, you can allow your medical POA agent to:

• approve or decline medical care, treatments, and medications
• access your medical records
• approve admission to or discharge from health care facilities
• authorize participation in medical research
• arrange or contract health care services or facilities
• manage or dismiss care personnel involved in your treatment
• make decisions about organ or tissue donation

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

Your MPOA agent cannot make financial or legal decisions on your behalf. They must also:

• follow your preferences when possible
• adhere to state laws
• avoid conflicts of interest
• observe ethical standards

What If I Don’t Have a Medical Power of Attorney?

If you become incapacitated and don’t have an MPOA, your next of kin or closest family members will typically receive the authority to make health care decisions for you. If you’re married, this person will be your spouse. Unmarried individuals’ next of kin usually goes in the order of adult children, parents, adult siblings, grandparents, and other relatives.

Local laws and regulations may affect what happens, but some traditional solutions without an MPOA include the following:

• Family consensus: If family members agree on care decisions and the state allows it, they may make them collectively.
• Court intervention: Family members may go to court if they disagree on care decisions, allowing a judge to appoint a single person to make all health care decisions.
• Default medical protocols: In emergencies, health care professionals may follow established protocols to provide ethical medical treatment.

How Do I Get a Medical Power of Attorney?

Creating a medical power of attorney lets you take control of your health care 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. Confirm they meet legal requirements, such as being at least 18 (in most states) and mentally competent. Ensure that the agent is willing to act on your behalf. Agents aren’t legally required to act if they don’t want to, so you should confirm your agent’s willingness to participate before adding them to your medical power of attorney document.

2. Define Your Agent’s Authority

Decide the specific medical decisions your agent can make, such as approving treatments, managing care, or consenting to procedures. You can limit your agent’s authority based on your preferences. Record your designations on your form for medical power of attorney.

3. Include Other Documents

Include other documents, like a living will or DNR, to give detailed instructions about your health care preferences. This way, your agent will have supplementary resources to inform the decisions they make that affect your well-being.

4. Sign & Share

Follow your state’s signing requirements, such as witnesses or notarization. Distribute copies to your agent, physician, and loved ones. Keep a copy with you during hospital visits for quick access.

How to Write a Medical Power of Attorney Form

Writing a medical power of attorney form lets you clearly state who has authority over your health-related matters if you become incapacitated. Plus, it lets you limit the scope of authority to what you’re comfortable granting. Follow these steps to write a legally sound MPOA.

1. Name Yourself as the Principal

Name yourself as the principal, who is the person who will benefit from the decisions made via the medical power of attorney. List your name, address, contact information, and date of birth. When you use our template, you can enter all your information in one place, and we’ll fill it in to round out the document.

2. Identify Your Agent(s)

Specify who your agent will be and provide their address and contact information, including their phone number and email address. Ensure that you have a conversation with them and confirm their willingness to act as your agent. If they’re not comfortable, choose someone else.

You can also name alternate agents in case your primary one becomes unwilling or unable to act on your behalf. Use our template to designate up to two alternate agents after your primary one.

3. Select Your Agent’s Powers

Select your agent’s powers to decide what they can and cannot do on your behalf. For simplicity, you can mark Yes or No for various pre-written powers in our template. If you want to be more specific about your agent’s authority and limitations, you can write out your own.

4. Finalize Details

Confirm that the document will only go into effect when a doctor deems you incapable of making decisions for yourself. Select who will acknowledge the document, whether it will be a notary public, two witnesses, or both. Review the document before signing in front of the required acknowledging parties.

What Are the State Signing Requirements for an MPOA?

Each state has different signing requirements. If you’re missing one or all required acknowledgments, a physician may not recognize your document and default to other decision-makers. Below, you can review the signing requirements for a health care power of attorney in each state, plus the official name to which this document is referred.

Can I Change a Medical Power of Attorney Form?

Yes. The easiest way to change a medical power of attorney form is to revoke the existing form and write a new one. You can revoke an existing medical power of attorney with Legal Templates’s revocation of power of attorney form. Follow your state’s requirements for witnesses or notarization to validate the revocation.

Provide copies of the revocation form to your former agent, health care providers, and anyone else with the original power of attorney for medical decisions. Then, you can appoint a new agent or update your preferences with a new medical power of attorney form.

Grant Medical Decision-Making Power Today

Gain control of your future by making a medical power of attorney form with Legal Templates. We help you document your desired attorney-in-fact who will make decisions about your health care. You can appoint and withhold certain powers so you remain in control even when you can’t speak for yourself or make decisions. Save time, money, and stress by using our lawyer-approved template.

Medical Power of Attorney Sample

Below, you can view an example of a medical power of attorney form to better understand its structure. When you’re ready, you can fill out your own via our medical power of attorney template.

universal-medical-power-of-attorney

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 health care decisions for you.

Frequently Asked Questions