Illinois Medical Power of Attorney Form [PDF]

Secure your healthcare preferences by creating an Illinois medical power of attorney using our specially designed document builder.

Last update: 28 Mar 2024

Illinois Medical Power of Attorney Form [PDF]

The Illinois medical power of attorney, or healthcare power of attorney, is a legal document that delegates the authority to make healthcare decisions from one person, called the principal, to another person, called the agent or attorney-in-fact.

The principal gives authority to the agent to decide on their behalf what treatments or medications they can be subjected to if the principal becomes unable to make decisions themselves. 

The principal will set medical power of attorney rights and limitations that will define the scope of the agent’s authority.

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

Laws and Legal Requirements

755 ILCS 45, Article IV, also called the Illinois Power of Attorney Act, regulates the status of medical power of attorney in this state, and  755 ILCS 45/4-5.1 provides that the principal must sign the medical power of attorney for it to be valid and effective. 

The principal's signature must be acknowledged by at least one witness. The state law doesn’t require the notarization of the document.

The Illinois medical power of attorney will remain effective until you revoke it or until you pass away. You can revoke the medical power of attorney at any time, regardless of your physical or mental condition. (755 ILCS 45/4-6)

How to Write a Medical Power of Attorney in Illinois

Here, you can see the step-by-step process of writing the Illinois medical power of attorney.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the Illinois medical power of attorney template. All you have to do is fill it out by following the instructions our advanced document builder provides.

First, you should provide the basic information, such as:

  • Full name, mailing address, and contact details of the principal

  • Date of issuing the medical power of attorney

#2. Appoint a Healthcare Representative

In this section, you should provide the following basic details about your agent or attorney-in-fact:

  • Agent’s full name

  • Agent’s mailing address

  • Agent’s contact details.

When choosing an agent that will represent you in this matter, you should choose someone who is of legal age and has the legal capacity to represent you. 

Moreover, considering the importance of the authority they will have in this matter, you should choose someone you can trust. This can be your spouse, a relative, a friend, or a trusted advisor. 

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, or secondary agent, is a person who will represent you as your healthcare agent in case your primary agent is not able or not willing to represent you.

The secondary agent should fulfill the same requirements as the primary agent. You can appoint one, two, or more secondary agents in the medical power of attorney. Here, you can also choose your spouse, a relative, a friend, or a trusted advisor to be your secondary agent.

#4. Identify the Witnesses and Have Them Sign the Form

After you have finalized the medical power of attorney form, you can print and sign the document. 

You must sign the document before at least one witness, who will also sign the document and confirm that you have personally signed the medical power of attorney. The agent must be an adult with the legal capacity to act.

#5. Notarize the Form

You should also have the notary public acknowledge your signature, even though it is not necessary by state law. They will notarize the document and confirm that you have personally signed it. This will additionally confirm the authenticity of the document and prevent potential fraud.

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