Free Fillable Michigan Medical Power of Attorney Form

Completing the Michigan Medical POA

Undoubtedly, not every citizen of the state of Michigan knows how to create such critical documentation as a power of attorney correctly. Considering this fact, we offer every interested Michigan resident various high-quality templates of a medical POA, which they can quickly download and fill out. Samples are available in formats supported by Microsoft Word, PDF readers, and OpenOffice.

Indicate the Personal and Contact Info of the Participants

All the parties should read the initial statement of a Michigan medical power of attorney form (aka the Form DCH-3916) before signing the proxy. After that, the owner of the healthcare POA who wishes to entrust decision-making rights concerning their life and wellbeing to the chosen patient advocate needs to enter their full name. Besides, they have to provide their complete mailing address and date of birth.

Once the principal finishes filling out their blanks, it is time to name the attorney-in-fact and describe their relationship with the declarant. In the prevailing number of cases, people choose their marital partner or a longtime friend to become their legal representative. But when it comes to a healthcare power of attorney, it might be a wise choice to assign your attending physician as your private attorney.

Hence, a medical proxy requires the selected agent to indicate their full name (title included) and full residential address. Sometimes, they also need to specify their contact details, such as the telephone number and e-mail address.

Sometimes, the “first option” is unable or unwilling to perform their duties outlined in an advance directive. For such instances, the grantor may designate successor agent(s). This person (people) will have to specify their name, relationship to the declarant, and full mailing address.

Set the Effective Date

The principal has the opportunity to choose the date when their legal paper will come into force. There are two options:

• The medical power of attorney takes effect immediately upon the grantor’s signing it.
• The healthcare proxy becomes effective only when it is determined that the principal is physically and mentally incompetent to make difficult decisions by themselves.

Define the Sphere of Authority

In this section, the creator of a Michigan medical POA must determine the assigned agent’s scope of authority and responsibility. It is vital to emphasize that the chosen individual will be obliged to act according to the existing proxy.

In general, the surrogate decision-maker is entrusted to give consent or refuse medical treatment in the grantor’s name. They are also allowed to have full access to medical records and all related documentation of the principal that might be requested by any government-sanctioned programs.

The Michigan advance directive owner may also exempt medical professionals who respect the patient’s wishes and directions, as defined here in this legal paper, from responsibility for complying with this proxy.

Work with Witnesses and Public Notary

Two witnesses viewing the signing of the healthcare power of attorney form must indicate their names, physical addresses, and signatures. The state notary, who must be present during the signing, should then fill out the remainder of the proxy and acknowledge it by signing and sealing it.