A Medical Power of Attorney form lets you choose an agent to make healthcare decisions for you ( the principal ) if you become incapacitated and unable to communicate your wishes.
The Medical POA goes into full effect only after a licensed physician deems the principal incapacitated and unable to make decisions.
Your agent can only act on your behalf regarding treatment, medication, or surgery options if your doctor determines you can’t make decisions for yourself due to dementia, coma, or other incapacity.
Medical Power of Attorney – by State
Since each state has unique legislation regarding this legal document, you must use the correct legal form.
- District of Columbia
- New Hampshire
- New Jersey
- New Mexico
- New York
- North Carolina
- North Dakota
- Rhode Island
- South Carolina
- South Dakota
- West Virginia
Statutory Forms – by State
You can find the official name below, as the name of the form differs by state.
|State||Official Name by State||Laws|
|Alabama||Advance Directive||§ 22-8A-4(c)(4)|
|Alaska||Advance Health Care Directive||AS 13.52.010|
|Arizona||Health Care Power of Attorney||§ 36-3224|
|Arkansas||Durable Power of Attorney for Health Care||§ 20-6-103|
|California||Advance Health Care Directive||PROB § 4701|
|Colorado||Durable Power of Attorney for Healthcare Decisions||§ 15-14-506|
|Connecticut||Advance Directive||Sec. 19a-575a|
|Delaware||Advance Health Care Directive||§ 2505|
|Florida||Designation of Health Care Surrogate||§ 765.202(1)|
|Georgia||Advance Directive for Health Care||§ 31-32-4|
|Hawaii||Advance Health Care Directive||§ 327E-16|
|Idaho||Living Will and Durable Power of Attorney||§ 39-4510|
|Illinois||Power of Attorney for Health Care||755 ILCS 35/3(b)|
|Indiana||Health Care Power of Attorney||755 ILCS 45/Art. IV|
|Iowa||Durable Power of Attorney for Health Care Decisions||§ 144B.5|
|Kansas||Durable Power of Attorney for Health Care||§ 58-632|
|Kentucky||Living Will Directive and Health Care Surrogate Designation||§ 311.629|
|Louisiana||Advance Directive||RS 28:223|
|Maine||Health Care Advance Directive Form||§ 5-805|
|Maryland||Advance Directive||§ 5-603|
|Massachusetts||Health Care Proxy||§ 201D-2|
|Michigan||Durable Power of Attorney for Health Care||§ 700.5501(b)|
|Minnesota||Health Care Directive||§ 145C.16|
|Mississippi||Advance Health-Care Directive||§ 41-41-209|
|Missouri||Durable Power of Attorney for Health Care||§ 404.822|
|Montana||Durable Power of Attorney for Health Care||§ 53-21-1304|
|Nebraska||Power of Attorney for Health Care||§ 30-3404|
|Nevada||Durable Power of Attorney for Health Care Decisions||NRS 162A.860|
|New Hampshire||Advance Directive||Section 137-J:20|
|New Jersey||Durable Power of Attorney for Health Care||§ 26:2H-57|
|New Mexico||Power of Attorney for Health Care||§ 24-7A-4|
|New York||Health Care Proxy||PBH § 2981|
|North Carolina||Health Care Power of Attorney||§ 90-321|
|North Dakota||Health Care Directive||§ 23-06.5-17|
|Ohio||Durable Power of Attorney for Health Care||Section 1337.17|
|Oklahoma||Durable Power of Attorney||§ 63-3101.4|
|Oregon||Advance Directive||ORS 127.527|
|Pennsylvania||Durable Health Care Power of Attorney||§ 5471|
|Rhode Island||Designation of Health Care Agent||§ 23-4.10-2|
|South Carolina||Health Care Power of Attorney||§ 62-5-504|
|South Dakota||Durable Power of Attorney for Health Care||§ 59-7-2.1|
|Tennessee||Durable Power of Attorney for Health Care||§ 68-11-1803(b)|
|Texas||Medical Power of Attorney||§ 166.161|
|Utah||Advance Health Care Directive||§ 75-2a-117|
|Vermont||Durable Power of Attorney for Health Care||18 V.S.A. § 9703|
|Virginia||Advance Directive for Health Care||§ 54.1-2984|
|Washington||Durable Power of Attorney for Health Care||§ 11.125.100|
|West Virginia||Medical Power of Attorney||§ 16-30-4|
|Wisconsin||Power of Attorney for Health Care||§ 155.30|
|Wyoming||Medical Power of Attorney||§ 35-22-403|
States have different requirements for MPOA forms to be witnessed, but they need to be authorized in the presence of witnesses, a notary public, or both. This is the requirement that your signature be witnessed.
|Alabama||Two (2) Witnesses||§ 22-8A-4|
|Alaska||Notary Public or Two (2) Witnesses||AS 13.52.010|
|Arizona||Notary Public or One (1) Witness||§ 36-3224|
|Arkansas||Notary Public or Two (2) Witnesses||§ 20-6-103(b)|
|California||Notary Public or Two (2) Witnesses||§ 4701|
|Colorado||No law (Notary Public recommended)||§ 15-14-506|
|Connecticut||Two (2) Witnesses||§ 19a-575|
|Delaware||Two (2) Witnesses||§ 2503|
|Florida||Two (2) Witnesses||§765.202 – §765.205|
|Georgia||Two (2) Witnesses||§ 31-32|
|Hawaii||Notary Public and Two (2) Witnesses||§327E-3|
|Idaho||No law (Notary Public recommended)||§39-4510|
|Illinois||One (1) Witness||755 ILCS 45/Art. IV|
|Indiana||One (1) Witness||§ 16-36-1-7(b)(3)|
|Iowa||Notary Public or Two (2) Witnesses||Chapter 144B|
|Kansas||Notary Public and Two (2) Witnesses||§ 58-625|
|Kentucky||Notary Public or Two (2) Witnesses||§ 311.621 -643|
|Louisiana||Two (2) Witnesses||§ 224 (A)|
|Maine||Two (2) Witnesses||§ 5-802 and § 5-804|
|Maryland||Two (2) Witnesses||§ 5-601, § 5-602, and § 5–603|
|Massachusetts||Two (2) Witnesses||Chapter 201D|
|Michigan||Two (2) Witnesses||§ 700.5506 to § 700.5515|
|Minnesota||Notary Public or Two (2) Witnesses||Chapter 14 C|
|Mississippi||Notary Public or Two (2) Witnesses||§ 41-41-201 to § 41-41-229|
|Missouri||Notary Public||§ 404.800 to § 404.865|
|Montana||Two (2) Witnesses||§ 50-9-103|
|Nebraska||Notary Public or Two (2) Witnesses||Chapter 30 § 3401-3432|
|Nevada||Notary Public or Two (2) Witnesses||NRS 162A.(700-865)|
|New Hampshire||Notary Public or Two (2) Witnesses||Section 137-J|
|New Jersey||Notary Public or Two (2) Witnesses||§ 26:2H-(53-77)|
|New Mexico||Two (2) Witnesses||§ 24-7A|
|New York||Two (2) Witnesses||PBH Article 29-C|
|North Carolina||Notary Public and Two (2) Witnesses||§ 32A, Article 3|
|North Dakota||Notary Public or Two (2) Witnesses||Chapter 23-06.5|
|Ohio||Notary Public or Two (2) Witnesses||§ 1337.11-1337.17|
|Oklahoma||Two (2) Witnesses||Title 63, Chapter 60|
|Oregon||Notary Public or Two (2) Witnesses||§ 127.505(-525)|
|Pennsylvania||Two (2) Witnesses||Chapter 54, Subchapters B and C|
|Rhode Island||Notary Public or Two (2) Witnesses||§ 23-4.10-2|
|South Carolina||Notary Public and Two (2) Witnesses||Title 62, Article 5|
|South Dakota||Notary Public or Two (2) Witnesses||Chapter 34-12C|
|Tennessee||Notary Public or Two (2) Witnesses||Title 34, Chapter 6, Part 2|
|Texas||Notary Public or Two (2) Witnesses||Title 2, Chapter 166|
|Utah||One (1) Witness||Title 75, Chapter 2a|
|Vermont||Two (2) Witnesses||§ 9703(b)|
|Virginia||Two (2) Witnesses||Title 54.1, Chapter 29, Article 8|
|Washington||Notary Public or Two (2) Witnesses||§ 11.125.400|
|West Virginia||Notary Public and Two (2) Witnesses||Chapter 16, Article 30|
|Wisconsin||Two (2) Witnesses||Chapter 155|
|Wyoming||Notary Public or Two (2) Witnesses||§ 35-22-403|
How to Get a Medical Power of Attorney
To create a legal Medical Power of Attorney, you must choose your agent, determine your agent’s authority, and sign the form according to your state’s requirements. If you wish, you may also include other advance directives (such as a living will).
Your form is legally binding once signed but only takes effect once a physician certifies you cannot make health care decisions.
Step 1 – Choose your agent
Most states legally require your agent to be 18+ years of age, mentally competent, and not an owner, operator, administrator, or employee of a healthcare facility where you’re a patient.
Your agent will advocate for your well-being and medical preferences while incapacitated. You should select a friend, family member, spouse, or professional who is:
- Someone you trust to follow your wishes and act in your best interests
- Knowledgeable of your desired treatments as well as religious and moral beliefs
- Emotionally capable of making difficult choices on your behalf
- Willing to accept the responsibility of the role
- Available to consult with your physician(s) to make decisions
A healthcare agent can also be referred to as a healthcare proxy, patient advocate, or surrogate decision-maker.
Step 2 – Define your agent’s authority.
It’s up to you to define the scope of your agent’s authority. Unless you include limitations in your MPOA form, they will have the power to make choices for you relating to your medical care, medications, treatments, surgeries, physicians, and more.
To ensure your wishes are followed, consider specifying whether your patient advocate can make decisions regarding the following:
- Life support, tube feeding, CPR
- Admittance or discharge from healthcare facilities
- Medical research
- Palliative care
- Organ or tissue donation
- Disease treatment
Step 3 – Include Living Will or DNR.
This gives your agent and healthcare professionals easy access to detailed healthcare wishes.
MPOA vs. Living Will
Medical powers of attorney and living wills are considered advance directives for health care. The two documents can often work together as part of a complete estate plan, but significant differences exist.
Unlike a Medical POA, a living will doesn’t appoint 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)
- surgical procedures
- palliative care
- other medical treatments
Your healthcare providers must follow any instructions in your living will and can’t be influenced by your family or friends.
Finally, a Living Will is only practical once you’re diagnosed as terminally ill, permanently unconscious, or declared to be in a similar end-stage condition. This means your document is powerless if you are temporarily incapacitated but are expected to recover.
Only a Medical Power of Attorney can guide in these situations.
Step 4 – Sign the form and distribute copies.
For your medical POA to be legally binding, it must comply with your state’s signing requirements. If you don’t follow those requirements, your signature may not be recognized, and your form might be deemed invalid.
Once you’ve certified your document with witness or notary public signatures, you should file the original in your records and distribute copies to your:
- Primary agent
- Alternate agent
- Primary physician
- Loved ones
- Healthcare institutions where you receive care
- Residential/palliative care facilities you live in
Always bring a copy of your MPOA if admitted to the hospital, even for an outpatient procedure.
Medical Power of Attorney Sample
Below is a free blank template you can download in PDF or Word format, print out, and fill out independently. Click on the download button at the bottom of the form, or view a filled-out PDF to see what the final draft should look like.
Although the document above is a good example, you should use a Medical Power of Attorney form specific to your state.
Frequently Asked Questions
Most states require you to sign the document in the presence of two witnesses or a notary public, and some states require both.
You can choose between a notary public or two witnesses in California and Texas. For example, Florida requires two witnesses’ signatures. Meanwhile, there are no requirements in Colorado. Nonetheless, we still recommend a notary public.
Your state may also impose restrictions on who can act as your witness. For instance, someone related to you by blood or marriage and/or your healthcare providers may be barred from signing as a witness.
[lt_faq_question tag="h3"]What happens if you have no Medical Power of Attorney?[/lt_faq_question]
[lt_faq_answer]If you become incapacitated and don’t have an MPOA, a legal guardian (often a family member) will be appointed to manage your medical affairs. Unfortunately, the person selected as your guardian might not be someone you trust to make decisions for you.
Yes. In most states, if you’re legally married and have never signed an MPOA, your spouse can make healthcare decisions on your behalf.
However, if you’ve used this document to appoint someone else as your agent, they can make your healthcare decisions over your spouse.
A Medical Power of Attorney lasts until:
- the principal (if competent) revokes it
- the principal dies
- the form includes a termination clause or expiration date
- the agent and any successor agents die, become incapacitated, or resign.
While competent, the principal can change the medical POA, including updating the agent and/or successor agents.
In addition to your primary agent, you can designate one or more alternate agents, also known as successor agents. Your alternate agent will assume responsibility if your first choice is unwilling, unable, or unavailable.
No, your agent is not responsible for your medical bills but only for making choices about your health. In addition, they cannot make financial arrangements unless you’ve designated them as your Power of Attorney over financial matters.