Free Fillable California Medical Power of Attorney Form

Filling out the California Medical POA Form

Filling out the California medical POA form is easy with the following steps.

1. Start by accessing the forms on this website in PDF or Word formats. You can download and fill them or even print them if you wish.
2. Open the form and make the necessary disclosures regarding it.
3. Identify the person you intend to appoint as an agent. You will fill out their name, physical address, state, zip code, and telephone number/s.
4. Define and qualify your agent’s authority. You should specify whether they will make medical decisions if you become blind, deaf, or immobilized. This way, your agent will not overstep their mandate and authority.
5. Determine when your appointed agent starts their work. If you want them to start immediately, you should mark a small box indicating that. Otherwise, they will wait for your doctor to confirm that you can’t make sound medical decisions before assuming office.
6. Specify if you want any of your body parts to go to donation after your death. For example, you can expressly state that you don’t wish any of your body organs to be donated. You may also authorize the donation of your entire body, or some of its parts, after your death.
7. Give clear instructions regarding decisions affecting your body after or shortly before death. For example, specify if you want medical workers to intervene in situations that could kill you. You may also indicate if you don’t want them to make any life-prolonging intervention if you face incurable diseases or are unconscious with no medical hope for recovering. This section also lets you forbid medical interventions whose costs outweigh their short-term benefits.
8. Indicate how you would like your agent to handle pain management. For instance, specify if you don’t want to undergo medical procedures that might cause you other complications like cancer, diabetes, and addictions.
9. Use this optional section to impose limitations on particular treatments, choose how your agent handles emergencies, and share your action plan for various medical scenarios.
10. Use this optional section to give more instructions on your body organs after death. You will clarify why you wish your body or its specific organs to be donated. Also, name the institutions to which you would like to donate those body parts.
11. You may restrict how you want your body parts to be donated. For example, you may instruct your body remains to be buried within three or five days after your demise.
12. Identify and designate your primary doctor. You have to give their name, physical address, city, state, and zip code.
13. Execute all your wishes with your medical POA.
14. Let two witnesses authenticate your signature on the document. Provide their names, physical address, states, zip codes, and telephone numbers.
15. One of your witnesses should satisfy any additional requirements.
16. Produce an additional witness signature as the circumstances may dictate. This requirement applies when the principal is a patient or a customer of a medical institution providing skilled nursing services. Your patient advocate will read this statement and agree with it by signing it. They will date and then sign the document. Their signing puts them under legal penalties if they testify to any falsehood.
17. Present the document before your notary public to notarize it. If you choose this path, follow their directions. They will duly print their name and sign the document to make it legally enforceable.