A power of attorney grants a third party authority to make decisions on your behalf when you are incapacitated. Although there are many different types of powers of attorney, a medical one gives another person the ability to make medical decisions for you when you are unable.
Sample Medical Power of Attorney
Each state has specific requirements for medical powers of attorney; a document that does not satisfy these requirements may be invalid. The attached sample medical power of attorney is not designed to conform to the laws in any specific state. Specific laws regarding medical powers of attorney can be found in a state's statutes.
This form is intended as an example, and not as a substitute for legal advice obtained from a lawyer licensed in your state. If you need help downloading the form, check out these helpful tips.
The first portion of the sample form states that the document is intended to act as a medical power of attorney and identifies the individual intending it to be such. Use the individual's full legal name to reduce the possibility of confusion. You may have to re-execute the document should the individual's name change in the future.
In the next section, the individual creating the document designates a surrogate and an alternate surrogate. An alternate surrogate serves when the initially designated surrogate is unable or refuses to act in that capacity. Both sections require not only identification of the surrogate by name but also by relationship, such as "father" or "spouse." This helps any physicians relying on the document in the future to know that they are dealing with the appropriate person.
The middle portion of this document details the surrogate's powers. These powers can be changed according to your wishes. Depending on your state's laws, you may be able to delete a power by drawing a line through it and writing your initials next to the deleted power.
The final section of the sample medical power of attorney is the execution portion. Many states require that the individual named in the document as well as two non-related witnesses sign and date this portion of the power of attorney. One of these witnesses may need to be a notary so that it is certain that the individual creating and executing the document is the person noted in the document.
Alternative Free Forms
Additional medical powers of attorney can be found online. Note that, once again, these forms may not be state-specific. Seek legal advice before completing and executing a medical power of attorney. Websites offering free medical power of attorney forms include:
- Expert Law: This website's free medical power of attorney contains multiple sections in which you can input the specifics you would like included in your form, such as limitations and the duration on the length of time that the form is to be in effect.
- Texas Medical Association: This association's form allows the completing individual to specify limitations and duration. It must be executed by two witnesses.
- Law Depot: This website allows users to input personal information and create a form that meets their needs. Users can choose the specific amount of power they intent to give and type of care they would like to receive under specific situations.
Seek Legal Review
Always seek legal advice prior to completing any free printable legal forms. A lawyer licensed in the state in which you intend to execute the medical power of attorney will be able to help you shape the form to suit your needs and ensure that your document fulfills state law.