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Home Personal & Family Power of Attorney Medical

Medical Power of Attorney (MPOA) Form

Let someone make medical decisions for you if you cannot do so.

Updated July 13, 2023 | Legally reviewed by Susan Chai, Esq.

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.

  • Alabama
  • Alaska
  • Arizona
  • Arkansas
  • California
  • Colorado
  • Connecticut
  • Delaware
  • District of Columbia
  • Florida
  • Georgia
  • Hawaii
  • Idaho
  • Illinois
  • Indiana
  • Iowa
  • Kansas
  • Kentucky
  • Louisiana
  • Maine
  • Maryland
  • Massachusetts
  • Michigan
  • Minnesota
  • Mississippi
  • Missouri
  • Montana
  • Nebraska
  • Nevada
  • New Hampshire
  • New Jersey
  • New Mexico
  • New York
  • North Carolina
  • North Dakota
  • Ohio
  • Oklahoma
  • Oregon
  • Pennsylvania
  • Rhode Island
  • South Carolina
  • South Dakota
  • Tennessee
  • Texas
  • Utah
  • Vermont
  • Virginia
  • Washington
  • West Virginia
  • Wisconsin
  • Wyoming
Table of Contents
  • Medical Power of Attorney - by State
  • Statutory Forms - by State
  • Signing Requirements
  • How to Get a Medical Power of Attorney
  • Medical Power of Attorney Sample
  • Frequently Asked Questions

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

Signing Requirements

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.

State Signing Requirements Laws
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.

If you’ve completed other Advance Directives, such as a Living Will or a Do-Not-Resuscitate form, you can attach them to your Medical Power of Attorney.

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)
  • dialysis
  • 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.

medical power of attorney form

PDF
Word

Although the document above is a good example, you should use a Medical Power of Attorney form specific to your state.

Frequently Asked Questions

Does a Medical Power of Attorney have to be notarized?


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.


Does your spouse automatically have Medical Power of Attorney?


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.


How long does a Medical Power of Attorney last?


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.


Can you have more than one MPOA agent?


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.


Is your Medical POA agent responsible for medical bills?


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.


Can your agent access your medical records?


Your patient advocate can access your medical records as outlined in the HIPAA Privacy Rule 45 CFR 164.524.

Related Will & Estate Planning Documents

  • Advance Directive: Declare your health care wishes if you’re incapacitated and can’t make your own decisions.
  • Do Not Resuscitate: States that you refuse resuscitation via CPR in the event that your heart stops beating or you stop breathing.
  • Living Will (Health Care Directive): Define your healthcare treatment and end-of-life decisions.
  • Last Will and Testament: Outline your wishes for how your property and affairs are handled when you pass away.

Create Your Medical Power of Attorney in Minutes!

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