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Medical Power of Attorney

    If you're looking to create a medical power of attorney to designate someone to make important decisions about your medical care, our template is just what you need. You'll find a simplified approach to drafting a medical power of attorney so it can be used to suit your needs. Our template is easy to understand, fill in and customize. It is reviewed by experts in this field, so you know you're in safe hands.

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Medical Power of Attorney
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Medical Power of Attorney

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Why should I care about drafting a medical power of attorney document? Can’t my spouse simply make decisions on my behalf in the event that I am lying helplessly on the sickbed, totally incapacitated? No they cannot.

There are certain restrictions imposed by the Health Insurance Portability and Accountability Act 1996 that do not allow your spouse or just about any relative to make medical decisions on your behalf. You can only appoint your spouse or any other person to access your medical records, and make medical decisions on your behalf using a medical power of attorney. In this article, we will be highlighting what a medical power of attorney is, its importance, contents and how it works.

 

What is the Medical Power of Attorney and its importance?

Medical power of attorney is a document that permits principals to choose whoever they want to make decisions regarding their health when they cannot do so themselves. It is mostly used when an individual is in a state of incapacitation, an example of such include being in coma, or any vegetative state or any form of mental ailment that affects the individual from thinking rationally.

It is required that this document is signed according to the laws of the different states which also requires the signature of or acknowledgment of one or more witness(es) and public officials.

At times, depending on the principal’s health, it is required that the principal drafts a living will and attaches it to his/her power of attorney so as to make it easier to decide the last wishes of the principal.

If durable, the agent is also permitted to aid in making financial decisions according to the wishes of the ill principal. The content of a medical power of attorney form varies from state to state. This is because it’s drawn to accommodate specific laws of the state

Get a copy of our medical power of attorney template!

Our medical power of attorney template documents have been written by legal experts to make sure you’re protected and your rights are met. It’s 100% free, so why not give it a try?!

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Importance of a Medical Power of Attorney

Imagine suffering a brain damage or stroke from a fatal auto crash? Who makes medical decisions for you? Your family? They definitely cannot make certain medical decisions for you if not granted powers by the law to do so. In these kinds of cases, a medical power of attorney can prove to be useful.

This document gives the representative the formal power to act on the principal’s behalf on all medical-related issues. Without this document, it would be hard for any medical personnel to administer care to the principals while they’re incapacitated.

The medical power of attorney is not a universal document so it’s important that while a principal thinks of creating a medical POA, he/she acquires the services of a legal advocate familiar with the process. This law practitioner can assist the principal in creating the document and stops you from omitting major rights from your agent’s powers.

Here are some salient points a principal must take note of when appointing an agent.

  • He/She cannot appoint his/her employee or medical provider as an agent
  • In many states, if the principal’s spouse is his/her own agent, the medical power of attorney becomes invalid upon their divorce.

 

Medical POA vs. Living Will

A medical power of attorney permits an individual to hand over authority about his/her life and health care to another individual while stating what he/she requires outrightly. This is very different from a Living Will which allows individuals to carry out their last plans before dying without anyone to order the medical staff towards their wishes. Follow the instructions according to the individuals’ wishes, which shouldn’t be changed for any reason by their family and friends.

 

What’s included in a Medical Power Of Attorney

Before drafting a medical power of attorney form, the principals must select who to entrust with the care of their wellbeing. While at it, they’re also required to choose a minimum of two alternate agents to cover up in case of the unavailability of the main agent.

Appointment of Health Care Agent:

This section requires information on the principal and the primary agent which includes their name, primary address, and state of residence with that of their agent. You also get to include the contact card of the agent with their email address.

Limitations on Agent:

In this section, the principal will include all the exceptions to the limit of powers the agent will have.

Appointment of Alternative Agent:

Here information on the two secondary agents will be provided in case the first agent is unavailable to perform his/her duties.

Document’s original and Copies:

Here the principal will state where the document’s original and copies should be logged.

Duration:

This section will indicate if the power of attorney medical will have a duration. This section is optional though except the principal wants to set a date.

Notary Public:

This page contains the document to be filled and signed by the notary public which would be present when the power of attorney medical form is signed. The witnesses should also append their signature and fill in their details.

 

How Does a Medical Power of Attorney Work?

The use of a medical POA is a straightforward process as users need to only download this form from places like CocoSign and fill in the necessary details. Once the details have been filled and signed, the document becomes valid.

At this point, the principals can no longer make a decision for themselves due to their ailment but before the agent starts making decisions, the sick would be confirmed by a physician to be incapable of making a decision for themselves..

If the principals become incapable of making their own decisions, the physician would state the cause.

If a person becomes incapacitated before creating a medical power of attorney the situation becomes complicated because no physician would agree to administer care. They would ask to see his/her medical POA first. Since the person can no longer create his/her own power of attorney or give consent to the document, what can be done is for his/her immediate family to seek help from the principal’s county court but they may have to spend some money and wait a while.

 

Get a copy of our medical power of attorney template!

Our medical power of attorney template documents have been written by legal experts to make sure you’re protected and your rights are met. It’s 100% free, so why not give it a try?!

Click the buttons here to get this template!

FAQs

  • I have a document from another state. Isn’t that good enough to be used in another state?

    It could be valid but the state medical professional would have to review the medical POA before honoring it. It is recommended that you share accurate information with your caregivers to ensure they understand your intentions for your decision-makers.

  • I have completed a durable power of attorney for health care before but I don’t have a copy presently.

    If you’re not with your document presently or have no idea of its location, no hospital would be able to honor it. To be able to honor your power of medical attorney, the hospital would need to see written documentation of your chosen decision-maker.

  • Can I change my mind?

    If you’re able to make your own decisions, you are free to change your paperwork whenever.

  • Can the medical power of attorney be revoked?

    It is possible to revoke your power of medical attorney in some states such as Colorado. The law also recognizes that under certain circumstances it can be revoked such as when you name your spouse as your agent and you guys get a divorce or legal separation later.

  • Does my medical POA include any legal requirements?

    Yes. The document must contain the legal words “This power of attorney shall not be affected by disability of the principal.” This is used when an individual is unconscious or not able to consent to his/her medical procedure.

The medical power of attorney is important. But not everyone knows how to create one on their own. This is where the services of CocoSign are essential as there are numerous free medical power of attorney you may want to check out. Their samples are easy to use and understand by both parties.

DOCUMENT PREVIEW

MEDICAL POWER OF ATTORNEY 

IMPORTANT INFORMATION

 

IT IS IMPORTANT THAT YOU REVIEW THE FOLLOWING INFORMATION BEFORE YOU SIGN THIS DOCUMENT. READ THE INFORMATION CAREFULLY AND SEEK GUIDANCE FROM A HEALTHCARE PROFESSIONAL OR ATTORNEY IF YOU DO NOT UNDERSTAND ANY OF THE TERMS.

 

By signing this document, you are giving authority to the person you are designating as your agent to make medical decisions on your behalf. Medical decisions can include any medical service, treatment, medical procedure, diagnosis or treat both mental and physical conditions. Your agent will be able to act with the same authority you would have if you were able to act for yourself and will have the authority to consent, refuse to consent to medical treatment including decisions about withdrawing or withholding life-sustaining treatment. It is, therefore, important that you know and trust your agent and that your agent is aware of your preferences for health care treatment.

 

Even after you sign this document, you will still be able to make your health care decisions assuming you are still considered mentally competent. Your agent cannot act on your behalf until your physician has determined that you are no longer physically or mentally able to make medical decisions.

 

The person you choose as your agent must be at least eighteen years old and someone that you trust with your health care. Your agent is not liable for any decisions they make on your behalf, as long as those decisions were made in good faith. You should make sure that you have chosen agent wants to take on the role as agent. Discuss your medical preferences with your agent so they are aware of your wishes. Review this document with your agent so they are aware of their role. You also may choose a back-up agent in case your other agent is unavailable to act. Your back-up agent should also be over 18 and aware of your preferences.

 

You may revoke this document at any time while you are still competent to do so. You may revoke it by telling your medical provider and your agent that you are revoking the document or you may provide them a written revocation. If you execute another power of attorney later, that will have the effect of revoking this one.

 

In order for this document to be valid, it must be signed in the presence of a notary or two witnesses. If you choose to have two witnesses sign, they must be at least 18, competent and independent and not your agent or related to your agent.

MEDICAL POWER OF ATTORNEY

 

  1. APPOINTMENT OF HEALTH CARE AGENT

 

I, _______________________________ (Principal’s Full Name) of _____________________________ (Principal’s Street Address), City of _____________________________, State of _________________ (HEREINAFTER known as the “Principal”) hereby appoint, _______________________________ (Agent’s Full Name) of _____________________________ (Agent’s Street Address), City of _____________________________, State of _________________ (HEREINAFTER known as the “Agent”)as my Agent to make any and all medical decisions on my behalf, except to the extent I limit those decisions in this document. This power of attorney takes effect if my doctor certifies in writing that I can no longer make my own health care decisions. My agent can be reached at the following contact information:
 

Home Phone :____________________ Work Phone : ____________________
 

Cell Phone: ____________________ E-Mail: ____________________________

 

  1. LIMITATIONS ON MY AGENT

 

My agent is authorized to make all medical decisions on my behalf EXCEPT for the following:

_______________________________________________________________

 

_______________________________________________________________

 

_______________________________________________________________

 

  1. APPOINTMENT OF ALTERNATE AGENT

 

If my agent appointed above is unable or unwilling to serve as my agent, I appoint the following person(s) to serve as agents in the order set forth below with the authority to make health care decisions on my behalf as provided herein:

 

  1. First Alternate Agent

 

Name: _____________________________________________________

 

Address: ___________________________________________________

 

Phone: _____________________________________________________

 

  1. Second Alternate Agent

 

Name: _____________________________________________________

 

Address: ___________________________________________________

 

Phone: _____________________________________________________

 

  1. ORIGINAL AND COPIES OF THIS DOCUMENT

 

The original document is/will be filed in the following place:

 

________________________________________________________________

 

________________________________________________________________

 

________________________________________________________________

 

I have/will provided copies of my medical power of attorney to the following:

 

 ________________________________________________________________
 

________________________________________________________________

 

 ________________________________________________________________

 

  1. DURATION

 

Unless stated otherwise herein, this document shall remain in effect until I revoke it. I understand that I cannot revoke this document during the time I am considered incompetent to make my own decisions.

 

(If applicable Initial and Check)

 

___________ ☐  (OPTIONAL) This power of attorney shall expire on ____ day

 

of _________________________, 20____.

 

  1. PRIOR MEDICAL POWER OF ATTORNEY

 

By signing this document, I hereby revoke any and all prior medical powers of attorney that I may have executed.

  1. EXECUTION

 

(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY. YOU MAY SIGN IT AND HAVE YOUR SIGNATURE ACKNOWLEDGED BEFORE A NOTARY PUBLIC

OR

 

YOU MAY SIGN IT IN THE PRESENCE OF TWO COMPETENT ADULT WITNESSES NOT RELATED BY BLOOD OR MARRIAGE.)

 

SIGNATURES

 

I /We hereby execute this document on ____ day of _____________________, 20____

 

in the City of ________________________, State of _______________.

 

 

Principal’s Signature _____________________ Print Name ______________________

 

Agent’s Signature _____________________ Print Name ______________________

 

1st Alt. Agent’s Signature ____________________ Print Name ___________________

 

2nd Alt. Agent’s Signature ____________________ Print Name ___________________

 

 

NOTARY ACKNOWLEDGMENT

STATE OF __________________

 

__________________ County, ss.

 

On this ____ day of __________________, 20____, before me appeared

 

____________________, as Maker of this Medical Power of Attorney who proved to me through government issued photo identification to be the above-named person, in my presence executed foregoing instrument and acknowledged that (s)he executed the same as his/her free act and deed.

     

_________________________________________

Notary Public 

 

Print Name: _____________________     

 

My commission expires: _____________________

 

 

 

WITNESS STATEMENT AND ACKNOWLEDGMENT:

 

I am not the person appointed as agent or successor agent in this medical power of attorney. I am not related to the maker of this document by blood or marriage. I am not entitled to any portion of the maker's estate, nor do I have any claim against the maker’s estate. I am not the attending physician of the maker or an employee of the attending physician. I am not involved in providing direct patient care to the maker and am not an officer, director, partner, or business office employee of the health care facility or of any parent organization of the health care facility.

 

SIGNATURE OF FIRST WITNESS

 

Signature: ________________________________________________

         

Print Name: ___________________________________ Date: __________

         

Address: __________________________________________________

 

 

SIGNATURE OF SECOND WITNESS

 

Signature: ________________________________________________

         

Print Name: ___________________________________ Date: __________

         

Address: __________________________________________________

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