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Free Fillable Medical Power of Attorney Form

There are unfortunate circumstances in which we have no other choice but to resort to a legal paper imposing the responsibility of making health-related decisions for us on someone else. One of such juridical documents is called a medical power of attorney form, which is often referred to as “health care proxy” or “advance directive.” With the help of this legal instrument, an individual can appoint a person to make medical-care decisions in their name solely if they are unable to do so on their own. A situation that may potentially require the availability of a power of attorney form can be caused by any disablement events. These include coma, apallic syndrome, or any other mental state that robs the principal (the creator of POA) of the ability to think soundly.

Fillable Medical Power of Attorney Form
Download your fillable Medical Power of Attorney Form in PDF format:
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Check Medical Power of Attorney Forms By State

As for the main requirements of the health care power of attorney, it should be signed in compliance with the legislation of the state in which the principal resides. Most often, the verification of such a contract will also require the presence of witnesses and/or a notary public. Keep in mind that your medical proxy comes into force only when you sign it. At the same time, the authorized agent is allowed to make tough health-involving calls, particularly upon you being deemed incapacitated.

The completion of a power of attorney for health care obliges an individual to select an attorney-in-fact, define their powers, sign the agreement in accordance with their state laws, include additional advance directives (e.g., a living will), and give out POA duplicates to all parties.

Medical POA Use Cases

While it would be perfect never to experience the need to resort to a health care proxy, life is unpredictable. Moreover, people grow old, and at the same time, they become limited in their physical and mental abilities. Due to this, the overwhelming number of holders of such a legal paper are elders. Unfortunately, youngsters and those who could boast of bursting with health also find themselves in situations that compromise their health and threaten their wellbeing. The health care power of attorney comes in handy when an individual no longer can function properly because of some tragic incident such as an automobile accident or cardiac arrest. Without a doubt, your attending physician will have to decide whether you are consistent enough to take your own decisions prior to assigning this authority to your representative. If it was determined that you are not able to make important decisions by yourself, the doctor would have to indicate the reasons for such a diagnosis.

Unluckily, becoming incapacitated in the absence of the MPOA is a truly unfortunate event. In such circumstances, the family or close friends of a disabled person have no right to compose this juridical document independently. The only way out is to seek custody in the district court dealing with such cases; however, it represents a money- and time-consuming process and will require the victim’s relatives to hire a lawyer.

Powers Granted

It is at your discretion to set the areas of the authority of your attorney-in-fact. Suppose the principal doesn’t indicate any particular limitations in their power of attorney for health care form. In that case, their agent will make tough calls instead of them regarding their health care, medications, procedures, surgeries, doctors, etc.

In brief, the appointed delegee will have to take care of the actions involving:

  • Emergency treatment, enteral feeding, cardiopulmonary resuscitation
  • Admission or discharge from medical institutions
  • Health screening
  • Palliative therapy
  • Organ and/or tissue donation
  • Disease management, etc.

Hence, be careful and thoughtful when deciding on whom to allocate as your designee.

How to Fill Out a Medical POA

Are you faced with the necessity to compose a health care proxy but feel too incompetent to write such a legal paper by yourself? Do not worry, as our free medical power of attorney form was designed to help you out. The customized template is available for download in the formats supported by such programs as Microsoft Word, Open Office, and any PDF reader.

Now let’s find out how to fill out such a form by following our comprehensive step-by-step guide.

Assign Your Private Attorney

The person you choose to be your representative will need to assume responsibility for taking vital decisions according to the state of your health. That is why it is crucial to designate a trustworthy individual who knows a lot about your medical history (for instance, cardiac output, allergies, prescribed medicine, and others).

In the event of your first choice for the agent’s position being unable to perform their duties, you may appoint a second attorney-in-fact. However, these individuals are not allowed to share authority since only one of them must be the decision-maker.

Besides that, the principal can provide the chosen person with certain compensation for accommodation, meals, and travel expenses.

Decide on Your Delegee’s Scope of Responsibility

Only the principal has the right to determine the sphere of responsibility to be endowed to their designee. Thus, it is possible to let your agent make any health-related decisions for you or to empower them to make the calls exclusively in the area specified by you. Giving a detailed explanation in regard to what your attorney-in-fact can and cannot do will ensure a better understanding of your health intentions by the medical staff.

Attach an Advance Directive

Frequently, the health care proxy comes hand in hand with a living will. The latter legal document contains your written preferences for life support and end-of-life treatment in described scenarios. The principal may choose to have the medical personnel who care for them strictly adhere to what they indicate in their advance directive or first follow the decision of the authorized person mentioned in the health care power of attorney. Such a legal instrument aims to inform the medical establishment and your MPOA donee of the health maintenance you prefer.

Fill Out and Verify the Form

Finally, the author of the health care POA and the allocated agent must certify the agreement by their signatures, simultaneously acting under the corresponding state statute. In general, a power of attorney for a health care contract is signed when a couple of witnesses and a notary are present. Once it is legally recognized, MPOA becomes permissible to apply. It goes without saying that the creator of the document must be in their right mind while writing it.

The private attorney is obliged to have the original of their form with them at the time of each incident. It is advised for you to present a copy of this legal paper to your general practitioner.

How to Choose an Agent for a Medical POA

By analogy with any other juridical document, the selected person to take on responsibilities for your life must be of the age of majority and older. They also should be sane and have no connections to the clinic where you are being treated. In most cases, people ask their family members, close friends, or trusted professionals to act as their agent.

Other requirements for choosing your patient advocate consist of the following:

  1. Opt for somebody you can entrust the fulfillment of your health-involving wishes.
  2. Choose a person who is aware of the treatment you would prefer and your beliefs.
  3. Select an individual capable of making tough calls in your name.
  4. Assign someone dependable and credible.
  5. Allocate somebody who can meet up with your primary care physician on a regular basis.

Taking into account every piece of advice given to you in relation to the appointment of the surrogate decision-maker grants you peace of mind under any circumstances.

Related Documents to Consider

As for the documents that are commonly used in the circumstances associated with a health condition and medical assistance along with (or instead of) MPOA, there are two legal papers for you to consider—a living will and a DNR form. The first one is often confused with a healthcare proxy, while in reality, it differs from the medical POA significantly. Such a juridical document as a living will allows an individual to lay end-of-life plans without appointing a patient advocate to help healthcare personnel to act according to their specified wishes. The directions provided in a living will in the written form must be strictly adhered to by the person’s primary care doctor. A living will cannot be altered in any way by relatives or friends of the patient.

Another legal instrument used in situations involving medical maintenance and wellbeing of an individual is called the DNR form or Do-Not-Resuscitate order. It is primarily used by patients, which express in writing their decision of not wanting to be reanimated if their heart fails or breathing stops. A DNR form is applied when people have terminal cancer or any other fatal disease and will most likely never recover. Resuscitation denial laws are regulated by each state in the US and are frequently accompanied by the mandatory condition that the patient approves their Do-Not-Resuscitate order by signing together with their attending physician, state notary, or witnesses.