Free Fillable Illinois Medical Power of Attorney Form

A serious disease or accident may happen when you are least prepared. When it occurs, you might need a trusted individual by your side to make critical treatment decisions on your behalf. Completing an Illinois medical power of attorney form earlier is a sure guarantee you will receive your treatment preference without fail.

Illinois medical POA is a vital legal agreement that permits you to choose a health care agent to execute all your medical wishes to the letter. However, the POA form becomes functional when the POA creator becomes incapacitated and can’t communicate with the attending physicians. In such a situation, the health care agent takes up the responsibility and consents to particular medical procedures as per the principal’s directives.

The person issuing directives is the principal, while the one accepting the role of a decision-maker is known as the health care agent.

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Illinois Requirements

Each power of attorney document has specific requirements like any other legal document. According to Illinois (755 ILCS 45/4-10), the form requires one witness to sign the document for validation purposes. The witness must be an individual of 18 years and above with good mental health.

The principal can also amend or revoke the POA form at any time (755 ILCS 45/4-6) by filling out a written revocation form with a valid date and signature.

The health care agent must also be 18 years and above and willing to take up the role without pressure.

On ilga.gov you can read all the information you need about Illinois statute and legislature regarding the medical power of attorney.

Filling Out the Illinois Medical POA

You must understand how to create an Illinois medical power of attorney form since it involves filling out the essential details. According to Illinois laws, you must complete this form and append your signature and have a witness to validate it. Below are steps to complete the Illinois document:

Principal Details

The principal must fill out their particulars on the document, full name, and physical address.

Health Care Agent

The next section is to select a reliable health care agent who will be the sole decision-maker when you can’t handle your medical affairs. Ensure that your agent is a reliable person who will execute your wishes objectively. After you have an individual in mind, inform them of the responsibility and fill out their full name, physical address, and working phone number.

Treatment Preferences

Here, the principal must clearly outline the instruction that they would like the agent to execute. For instance, specific treatment procedures and critical decisions when the principal suffers incapacitation and cannot communicate. Whether the agent can accept or refuse treatment from attending physicians in certain situations.

The document also allows the principal to assign powers to the agent to conduct an autopsy, organ donations, or body disposition.

Agent Authorization

This section permits the agent to execute critical decisions when the principal suffers incapacitation due to illness or mental condition.

Life-sustaining Treatments

In Illinois, the principal has a say on life-sustaining procedures that prolong life. In this section, you can tick only one box. It offers two options, where one states that no matter the circumstance, the attending physicians must keep you alive. While the other option allows the doctors to end the life-sustaining treatments if they believe you are in a vegetative state and will not recover.

Limitation of Powers

As much as the agent has the authority to make critical health decisions, the principal can limit some of the powers. In this section, the principal must clearly state the specific limits to the granted powers to prevent the agent from going beyond their mandate.

Alternative Health Care Agents (Optional)

This section is optional since a principal is free to add other alternate agents. It is essential because the original agent may fail to take responsibility due to incapacitation or other reasons. However, only one agent can act when necessary. Fill out the agents’ particulars on the document – full name, physical address, and telephone number.

Witness and Signatures

Finally, append your signature and current date on the document. Have your witness also sign the form and include their full name, physical address, signature, and date.