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Medical Power of Attorney Forms

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Medical power of attorney forms, also known as an ‘Advance Directive’ or ‘Health Care Proxy’, is a form that allows a person to elect someone else to handle health care decisions on their behalf only if they are not able to do so themselves. The situation that would require this could be due to any type of incapacitation event such as a coma, vegetative state, or any type of mental condition that impairs the principal from thinking rational. The document must be signed in accordance with their respective State laws which usually requires either witness(es) or a notary public to view the signatures of the parties.

Table of Contents

Forms By State

Power of Attorney vs Living Will

Health Care Power of Attorney – A document that allows an individual to give someone else the right to make decisions about their end of life treatment options while guiding their intentions in the form.

Living Will – Sets a person’s end of life plans in a concrete manner without the use of surrogate to help guide medical staff as to their wishes. The instructions written are to be followed by the patient’s primary care physician and cannot be changed by friends or family.

Laws by State

How to Write

To write a medical power of attorney the principal, or person granting power, will have to elect someone to handle their health care decisions (along with up to two (2) ‘secondary’ or ‘alternate’ agents in the chance the first does not show). Once a representative has been decided begin by filling in the following:

Step 1 – In Section I (Appointment of Health Care Agent) the Principal and Agent full name and address. At the bottom of the section, the home phone, work phone, cell phone, and e-mail of the agent should be written.

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Step 2 – In Section II the principal should include any exceptions (if any) from the broad powers the agent will have.

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Step 3 – In Section III, the principal has the option of selecting up to two (2) alternate agents in the chance individuals are unavailable for act for the principal.

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Step 4 – In Section IV list the locations where originals and copies of this document will be held.

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Step 5 – In Section V, if the power of attorney will have a end period check the box and initial with the date that the form expires.

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Step 6 – On the last two (2) pages the individuals listed should sign the form in the presence of a notary public and/or two (2) witnesses that are not in any way connected (blood/marriage) with the parties authorizing the form.

  • Notary Public

All parties of the document must be present with the Notary Public.

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  • Two (2) Witnesses

If the State requires two (2) witnesses then the Witness Acknowledgment must be signed on the last page.

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Signature & Witness/Notarize

All medical power of attorney forms must be signed in the presence of either witness(es) and/or a notary public. The following States require these specific rules in order for the Principal’s signature to be recognized.

  • AL – Two (2) Witnesses.
  • AK – Two (2) Witnesses or Notary Public.
  • AZ – One (1) Witness not related by blood or Notary Public.
  • AR – Two (2) Witnesses.
  • CA – Two (2) Witnesses.
  • CO – Two (2) Witnesses.
  • CT – Two (2) Witnesses and a Notary Public.
  • DE – Two (2) Witnesses.
  • FL – Two (2) Witnesses.
  • GA – Two (2) Witnesses.
  • HI – Two (2) Witnesses or a Notary Public.
  • ID – Two (2) Witnesses and at least One (1) of the Witnesses signing in front of a Notary Public.
  • IL – One (1) Witness that cannot be related by blood or marriage.
  • IN – Two (2) Witnesses and at least One (1) must be a disinterested party.
  • IA – Two (2) Witnesses or a Notary Public.
  • KS – Two (2) Witnesses not related by blood or marriage or a Notary Public.
  • KY – Two (2) Witnesses or a Notary Public.
  • LA – Two (2) Witnesses not related to the Principal by blood or marriage.
  • ME – Two (2) Witnesses.
  • MD – Two (2) Witnesses.
  • MA – Two (2) Witnesses.
  • MI – Two (2) Witnesses.
  • MN – Two (2) Witnesses or a Notary Public.
  • MS – Two (2) Witnesses not related by blood/marriage or a Notary Public.
  • MO – Two (2) Witnesses and a Notary Public.
  • MT – Notary Public.
  • NE – Two (2) Witnesses or a Notary Public.
  • NV – Two (2) Witnesses or a Notary Public.
  • NH – Two (2) Witnesses or a Notary Public.
  • NJ – Two (2) Witnesses.
  • NM – Two (2) Witnesses.
  • NY – Two (2) Witnesses.
  • NC – Two (2) Witnesses and a Notary Public.
  • ND – Two (2) Witnesses or a Notary Public.
  • OH – Two (2) Witnesses or Notary Public.
  • OK – Two (2) Witnesses.
  • OR – Two (2) Witnesses (One (1) of the Witnesses may not be related by blood or marriage).
  • PA – Two (2) Witnesses.
  • RI – Two (2) Witnesses or a Notary Public.
  • SC – Two (2) Witnesses not related to the Principal by blood or marriage.
  • SD – Two (2) Witnesses or a Notary Public.
  • TN – Two (2) Witnesses or a Notary Public.
  • TX – Two (2) Witnesses or a Notary Public.
  • UT – One (1) Witness that cannot be related to the Principal via blood or marriage.
  • VT – Two (2) Witnesses.
  • VA – Two (2) Witnesses.
  • WA – Notary Public.
  • WV – Two (2) Witnesses and a Notary Public.
  • WI – Two (2) Witnesses not related by blood or marriage.
  • WY – Notary Public.

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