Instructions and Forms to Complete a Medical Power of Attorney
Follow these steps to complete a Medical Power of Attorney form.
Get the Medical Power of Attorney form here:
- Complete the form in blue or black ink.
- Name the person you would want to be your agent in the event of your incompetency.
- Write any limitations on the decision-making authority of your agent that you want to include.
- Name any alternate agents if your first choice cannot serve at the time of your incompetency.
- Sign and date the form in front of a notary OR in front of two witnesses. Also have the notary or witnesses sign and date the form.
Or use the following guided form:
Keep the original and give a copy of the Medical Power of Attorney to your:
- Any alternate agents, and your
- Health care and residential health care provider(s).
Providing these copies helps secure a smooth transition in the event you become incompetent.
Get help filling out the form by talking with your:
- Health care provider,
- Residential health care provider, or
You can also use this guided form:
You do not have to have a lawyer, but naming an agent in a power of attorney is an important decision and having legal help can be a good idea. If you decide that you need legal help, there are options.