Free medical power of attorney form

How to fill it in

Filling in a medical power of attorney is mostly a matter of naming the right people and stating your wishes clearly. Take your time on the agent and your instructions, since those are what doctors will rely on.

• Agent: name the person you trust to make your health care decisions, with their phone number, and name an alternate in case your first choice cannot serve.
• Powers and limits: confirm the decisions your agent can make, and write in any limits or specific instructions, or note that there are none.
• Your wishes: state your wishes about life-sustaining treatment, or note that they are set out in a separate living will.
• Records: the template lets your agent see your medical records so they can make informed decisions.
• Sign it your state's way: sign in front of the witnesses or notary your state requires, using your state's official form where it has one.
• Share it: give copies to your agent, your alternate, your doctor, and close family.

Medical POA vs. living will and other documents

A medical power of attorney is one piece of a set of documents that people often confuse. A living will is different: it states your own wishes about end-of-life care, such as whether you want life-sustaining treatment if you are terminally ill or permanently unconscious. A medical power of attorney does not state those wishes; it names the person who will decide. The umbrella term for both is an advance directive, and many states combine the two into a single advance directive form, so you name an agent and record your treatment wishes in one place. Two other documents are separate again. A financial power of attorney covers money and property, not health. A HIPAA authorization lets named people see your medical records but gives no authority to make decisions, though your health care agent generally gets records access as part of the role. For full coverage, most people pair a medical power of attorney with a living will, so they have both who decides and what they want.

Who to choose as your agent

Your agent should be someone you trust completely and who is willing to speak up for your wishes, even under pressure from doctors or family. Choose one primary agent and at least one alternate, in case your first choice is unavailable when needed. Talk to the people you name so they understand your values and what you would want; the document works best when your agent already knows your wishes. There are limits on who can serve. Your agent can be any competent adult, but your treating doctor or a provider caring for you usually cannot be your agent unless they are family, and the rules vary by state. The person you name as agent also cannot act as one of your witnesses. Naming co-agents who must agree is possible in many states but can lead to deadlock, so a primary-plus-alternate setup is usually the cleaner choice.

When it takes effect and how long it lasts

A medical power of attorney is usually springing, which means it takes effect only when you cannot make your own health care decisions, not before. The trigger is typically your attending physician determining that you cannot make or communicate decisions; some states or forms require more than one doctor. While you still have that ability, you remain fully in charge, and your agent cannot overrule you. The document is durable, meaning it stays in effect through your incapacity, which is the whole point. It lasts until you revoke it, until you regain capacity, or until your death, when authority passes to your estate's representative. You can revoke it at any time while you are competent, by signing a revocation, signing a new one, or clearly telling your provider. In some states, a divorce automatically cancels a spouse-agent's authority, in which case your named alternate steps in, so review the document after any major life change.

How to sign it, by state

How you must sign a medical power of attorney is set by your state, and this is the step people most often get wrong. There is no single national rule. Most states require you to sign in front of either two qualified witnesses or a notary, and some require specific formalities. For example, Texas lets you use two witnesses or a notary, either one; Florida and New York require two adult witnesses and do not require a notary; and California accepts two witnesses or a notary, with extra formalities, such as notarization, for a directive signed electronically. The one rule that holds almost everywhere is that the person you named as your agent cannot serve as a witness, and many states also bar your attending doctor, your relatives, your heirs, and anyone financially responsible for your care from witnessing. Because the rules vary this much, and a document signed the wrong way may not be honored when it matters, use your state's official medical power of attorney or advance directive form and follow its signing instructions exactly. The witness and notary blocks in this template are there to complete according to your state's requirements.

Can you sign a medical power of attorney online?

Because we make electronic signing easy, it is worth being clear about where a medical power of attorney is different. For ordinary contracts, an electronic signature is valid across the country under the ESIGN Act and UETA. A medical power of attorney is not an ordinary contract. It is a health care directive, and how it may be signed is governed by your state's own rules, which often call for in-person, wet-ink signing in front of witnesses or a notary. Some states do allow electronic execution: Texas, for instance, permits a digital or electronic signature on a medical power of attorney if the statutory requirements are met, and Maryland runs a state electronic advance-directive program. Many other states do not clearly authorize it. So the safe approach is this: an electronically signed medical power of attorney is valid only where your state law allows it, and when you are unsure, sign on paper with the witnesses or notary your state requires. Use online signing for the ordinary documents where it plainly applies, and check your state before relying on it for a health care directive.

After you sign it

A medical power of attorney only helps if the right people can find it when it matters. After you sign it the way your state requires, give copies to your agent and any alternate, your primary doctor and any specialists, and close family members, and keep your own copy somewhere accessible rather than locked away where no one can reach it in an emergency. Add it to your medical records if your provider will store it. Review the document after major life events, such as a marriage, a divorce, a serious diagnosis, retirement, or a move to another state, since a move in particular may mean you need to redo it on the new state's form. Pairing it with a living will gives your agent both the authority to decide and a clear record of what you want.