California Medical Power of Attorney Form [PDF]

Read our comprehensive guide on appointing someone to be your healthcare agent using the California medical power of attorney.

Customized for CaliforniaThis document may be legally binding in California according to your state specific regulations.
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  • Last reviewed on April 27th

The California medical power of attorney, or healthcare power of attorney, is a legal document that allows the person called the attorney-in-fact or the agent to act on behalf of the person called the principal and make decisions about their healthcare.

The principal can issue the medical power of attorney if they have been diagnosed with a terminal illness, are of old age, or are in unstable health, and there is a high possibility that they will not be able to make decisions in the future.

Laws and Legal Requirements for a Medical Power of Attorney in California

Laws and Legal Requirements

Sections 4680 to 4691 of the California Probate Code regulate the medical power of attorney rights and limitations in this state. 

According to sections 4674 and 4675, the principal must sign the medical power of attorney form in front of at least two witnesses and a notary public. A patient advocate or ombudsman should also sign the power of attorney if the principal is a patient in a skilled nursing facility.

Sections 4695 to 4698 provide that the principal is allowed to revoke all or a part of the healthcare directive, except for the designated agent. The medical power of attorney can be revoked at any time and by any means of communication. 

How to Write a Medical Power of Attorney in California

To make a valid and effective medical power of attorney that’s in line with California state laws and regulations, you should follow the steps outlined in the section below:

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you will find the California medical power of attorney template. You have to fill it out with the relevant information according to your preferences regarding the medical treatment you want or don’t want to be subjected to. 

Our advanced document builder will provide you with the relevant information for every section of the document you are filling out.

#2. Appoint a Healthcare Representative

This is your attorney-in-fact or an agent. It should be an adult with the legal capacity to represent you. You should choose a reliable and trustworthy person, considering the importance of the matters they will have authority over.

In this section, you should enter the full name, mailing address, and contact details of your agent. 

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, also called the secondary agent, will act only if the primary healthcare representative is not able to represent the principal. They have the same scope of authority and should fulfill the same requirements as the primary healthcare representative.

#4. Define the Scope of Authority

The medical power of attorney rights and limitations will define the scope of authority for the attorney-in-fact. Here, you will provide your preferences in terms of accepting or not accepting to be subjected to a certain type of treatment, medication, life support, resuscitation, organ donation, and other medical interventions.

#5. Identify the Witnesses and Notarize the Form

Finally, you should sign the document in front of at least two witnesses and have it notarized. The notary public will identify all the parties signing the document and confirm that they have signed it. This will increase the authenticity of the document and provide additional security for all the parties involved. 

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