Medical Power of Attorney (MPOA) Form

A medical power of attorney (MPOA) lets you choose an agent to make healthcare decisions for you (the principal) if you become incapacitated and unable to communicate your wishes. The MPOA goes into full effect only after a licensed physician deems the principal incapacitated and unable to make decisions about their future medical care.

Medical Power of Attorney – By State

Table of Contents

• Medical Power of Attorney - By State
• Statutory Forms - By State
• Signing Requirements
• What Is a Medical Power of Attorney?
• Why Do You Need an MPOA?
• What Can Your Healthcare Agent Do?
• How to Get a Medical Power of Attorney
• How to Revoke a Medical Power of Attorney
• Medical Power of Attorney Sample
• Frequently Asked Questions

Statutory Forms – By State

You can find the official name for a medical POA below, as the form’s name differs by state.

Signing Requirements

States have different signing requirements for MPOAs. Some require you and the health care agent to sign the form before witnesses, a notary public, or both. Explore the state-specific requirements below.

What Is a Medical Power of Attorney?

A medical power of attorney lets you choose a person, often a family member or close friend, to make healthcare decisions on your behalf if you become unable to do so.

Once a licensed physician deems someone incapacitated, a medical power of attorney can go into effect. At this point, the principal’s agent can make decisions based on the guidelines within the signed healthcare power of attorney form [1] . This way, an agent can make decisions according to the principal’s treatment preferences.

MPOA vs. Living Will

A medical power of attorney and a living will are both types of advance directives. The two documents can often work together as part of advance care planning, but 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

In most cases, a living will is only practical once you’re terminally ill, permanently unconscious, or in an end-stage condition. Because of this stipulation, a living will is powerless if you’re temporarily incapacitated but have a high chance of recovering.

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.

Some reasons to consider getting an MPOA include the following:

To Address Health Concerns

A principal may consider getting an MPOA after they’ve received a serious diagnosis. If you’ve been diagnosed with a degenerative condition or a condition that has no cure, you may want to designate a medical power of attorney to ensure you can properly communicate your desires for your care.

To Prepare for a Procedure

If you have an upcoming medical procedure, you may consider assigning a healthcare power of attorney. Whether the procedure is major or minor, things may not go according to plan. If you’re under anesthesia, you won’t be able to know what’s going on or consent to unplanned treatments that may become necessary.

To Create Peace of Mind

Even if you don’t have any health problems, unforeseen events can lead to you becoming temporarily incapacitated. You can save your family members from excess emotional stress and hardship by clearly assigning an agent and outlining their powers.

What Can Your Healthcare Agent Do?

Your agent’s powers depend on how much authority you grant them in your healthcare power of attorney. Depending on your preferences, you may grant them a wide scope of powers or very limited ones.

Some examples of the powers you can grant them include the following:

• Agree to, refuse, or withdraw consent to any type of medical care, tests, procedures, treatment, and medications.
• Access your medical records.
• Authorize your admission or discharge from a healthcare facility.
• Authorize your participation in medical research.
• Contract for any healthcare-related service or facility on your behalf (without accepting financial responsibility).
• Hire/fire medical, social service, or other personnel who are responsible for your medical care.

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. You may also include other advance directives, such as a living will, if you wish.

Your form is legally binding once signed but only takes effect once a physician certifies you cannot make your own decisions.

Follow the below steps in detail to get your MPOA.

Step 1 – Choose Your Agent

Most states legally require your agent to be at least 18, 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 health care decisions

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 help increase the chances of a medical team fulfilling your wishes, 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 a Living Will or DNR

If you’ve completed other advance directives, such as a living will or a do-not-resuscitate form, you may be able to attach them to your medical power of attorney.

Attaching these documents gives your agent and healthcare professionals easy access to your detailed healthcare wishes.

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. Your signature may not be recognized if you don’t follow those requirements. As a result, your form may be 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(s)
• 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.

How to Revoke a Medical Power of Attorney

Revoking a medical power of attorney is relatively simple. You can do so as long as you’re mentally capable.

Fill out a revocation of power of attorney form and obtain the required witness and notary signatures for your jurisdiction.

Once you revoke your existing form, you can appoint a new agent or adjust your agent’s powers by filling out 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.

DOWNLOAD PDF

DOWNLOAD MS WORD

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