A medical power of attorney form is a legal form or document which is intended to authorize an individual in making medical and health-related decisions to a person in need such as a person with a disability or a minor. With this type of document, the authorized person will be able to permit a medical procedure, allow a physician to administer exams and provide medications to the incapacitated individual. Moreover, since this is a legal form, it is important that there are witnesses who will be signing the form along with the notarization seal of a licensed notary public or attorney.

Types of Medical Power of Attorney Forms

There are only a few types of the medical power of attorney forms and these are as follows:

Combined Medical Power of Attorney and Living Will Form – This type of medical power of attorney is accompanied by a living will. The objective of this document is to not only assign an authorized person who will be making the medical and health-related decisions for an individual but also for acknowledging his living will or his wishes prior to his death. In the form, the person who is the owner or the maker of the living will state his personal information and his choice of a representative who will be acting on his behalf in the event of his incapabilities. His choice of a successor representative will also be identified in the form along with his other directives, and the notarization of his chosen notary public attorney. Moreover, if the principal or the person using the form wants the completed document to be sent to the registrar of the State, then he must mark the “Opt-In” option at the topmost portion of the form to indicate his approval in sending the form.

Combined Medical Power of Attorney and Living Will Form

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Enduring Medical Power of Attorney Form – If the intent of the principal or the person assigning the power is to authorize someone and have the legal authorization be retained even if he will be incapacitated, then an enduring medical power of attorney form is the exact document to create. This form will legally bind the authorized person in conducting and making decisions in lieu of the subject of the medical power of attorney. In the form, there is a section which is intended to provide the details and answers on some questions related to the topic such as the limitations and the provisions to be acknowledged when determining who can serve as witnesses for statutory declarations. Additionally, enduring medical power of attorney forms can also be used if the principal and the person whom the medical decisions will be provided for owns properties. This allows the authorized representative to make property related decisions during the individual’s incompetence due to his medical condition.

Enduring Medical Power of Attorney Form

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Moreover, there is also the durable medical power of attorney form which is suitable to be used similarly to the aforementioned enduring medical power of attorney. However, the two differ on the range of responsibilities for the authorized person since in a durable medical power of attorney, the authorized person will not be permitted to conduct property-related business or decisions for the subject of the document which means his role is limited in the medical field only.

Medical Durable Power of Attorney Form

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Steps to Make an Effective Medical Power of Attorney Form

Some legal forms are easy to create while there are others which demands the expertise of an individual regarding the subject to be discussed in the document. And in making a basic type of medical power of attorney, the steps below can be followed yet must be reviewed before it will be signed by anyone involved in it:

Step 1: Prepare the document sheet to be used.

In preparing the document sheet to be used, the margins, the font styles, and sizes, as well as the header must be decided upon. The header should contain the title of the document along with the document number and an area for indicating the date of when it was used by the parties involved in the power of attorney. In addition, a statement with an explanation of the power of attorney and the validity of it, including the roles and responsibilities of the person to be authorized should also be stated with a signature block for the authorizing party.

Step 2: Layout the designations of each party involved.

The party designation sections are intended to disclose the general information of the people involved in the power of attorney. The first designation section should be filled out by the authorizing party to identify his choice of designated health care agent. In this section, the name of the person assigned or appointed by the authorizing party will be disclosed as well as his address and phone number. Additionally, a few tips and notes that the authorizing party must keep in mind is also enlisted such as the limitations of an individual in exercising the authority of the assigned agent. The second designation section will be for identifying who will be assigned as an alternate agent in place of the authorized agent’s absence. There can be two alternate agents and each of their contact information must be enlisted in this section of the form. Other pieces of data and information to include is the complete address of the location where the original medical power of attorney form is kept and recorded along with the names of individuals who have duplicates of the document as their own personal copies.

Step 3: State the duration.

From and till when the power of attorney will be executed is the focus on this portion of the form. If there is not a definite date of the end of the agreement and medical authorization, then the parties must agree on a range of days or years when the agreement will be terminated. Revocations and termination rules can also be stated along with the defined period or duration of the authorized power.

Step 4: Include an acknowledgment statement of disclosure.

The medical power of attorney is not the only document which is intended to be signed and be provided to the party’s involved since there must also be an information sheet and a statement of disclosure. These documents will help in informing the authorized agent or agency about the expectations of the authorizing party as well as the risks that the authorized agent should acknowledge as part of his role.

Step 5: Add a statement of witnesses.

The witnesses who will be signing the form must agree on an acknowledgment about their role as well as in clarifying that they are not the appointed authorized person for the medical power of attorney. Along with the witness statement would be the area for the general information of each witness which should include their name, address, and the date of when they affixed their signatures on the form.

Step 6: Allocate a notary section.

This is the last portion of the form where the notary public will have to state his information such as his name, the date of when he notarized the power of attorney and his notary seal. Without an official notary or notarization seal, the power of attorney will not be considered as a valid and legal document.

Medical Power of Attorney Form Sample

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Tips on Creating a Medical Power of Attorney Form

Creating a medical power of attorney form needs the expertise of an attorney or someone who can legally give a piece of advice and aid in making legal documents in order to meet the requirements of the State or country where the form will be used, completed, and signed. Some tips to remember when making a medical power of attorney form are enlisted below:

  • Blank spaces must be present where pieces of data and information will be filled in by the user. Since it is a form to be made, the specific details of the agreement, limitations, and the general information of the parties involved in the power of attorney form should be left blank or with an underline placeholder for each data area.
  • The signature block should permit more than one witness’s signature. The role of a witness is to acknowledge and be the proof that the negotiation or agreement between the parties involved actually happened in the presence of a legal attorney.
  • There must be full details and explanations about the limitations and inclusions of the power of attorney. When granting any type of legal authorization, it is important that the authorized person is properly informed of the various limitations and obligations which must be met by him during the period of the authorization or the power of attorney.

Lastly, the form or the document must be made with the aid and the presence of an attorney. The attorney who will be providing guidance should be someone who is reputable and knowledgeable about legal, medical concerns and related subjects. This is to assure that the terms, statements, and all the contents in the POA are legally based on the regulations of the State and country.

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