Massachusetts Medical Power of Attorney Form [PDF]

The Massachusetts medical power of attorney, or healthcare power of attorney, is a legal document that enables one person, called the principal, to authorize another person, called the agent, or the attorney-in-fact, to represent their interests and make decisions about their healthcare on their behalf.

The principal should issue a medical power of attorney in situations where they are diagnosed with a terminal illness or are facing serious surgery, and there is a possibility that they won’t be able to make their healthcare decisions themselves.

The principal can then use the medical power of attorney to indicate what medical treatments they want or don’t want to be subjected to.

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

Laws and Legal Requirements

Part 2, Title 2, Chapter 201D of the Massachusetts General Laws regulates the status of medical power of attorney in Massachusetts.

Chapter 201D, Section 2, provides that the principal can sign the medical power of attorney personally, or the document can be signed by another person in the presence of the principal. There must be at least two adults present to witness the signature. A person appointed as an agent cannot serve as a witness.

Chapter 201D, Section 7, provides that the principal can revoke the medical power of attorney at any time unless the court determines that they are no longer capable of making decisions. If the agent is a spouse, after a divorce, the medical power of attorney will automatically be revoked.

How to Write a Medical Power of Attorney in Massachusetts

To make a valid and effective medical power of attorney that’s in accordance with Massachusetts laws and regulations, follow the step-by-step process outlined below.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you should access the medical power of attorney template and fill it out with the help of our professional legal document builder. The builder will provide you with relevant information on filling out each field in the medical power of attorney form.

First, you should provide the following information:

Date of issuing the power of attorney
Principal’s full name, mailing address, and contact details

#2. Appoint a Healthcare Representative

In this section, the builder will instruct you to enter details about the person you want to appoint as your healthcare representative or agent. You should enter their full name, mailing address, and contact details.

The attorney-in-fact should be of legal age and have the legal capacity to act. Moreover, you should appoint someone you can trust, considering the importance of the authority they will have over your healthcare.

Here, you can include the medical power of attorney rights and limitations that your agent can have.

#3. Identify an Alternative Healthcare Representative

This person is also called the secondary attorney-in-fact or a secondary agent. They act and make decisions about your healthcare in case your primary agent becomes incapacitated or becomes, in some way, unable to represent you.

The secondary agent should fulfill the same exact requirements as the primary agent. You can name one or more people as your secondary agents.

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

After finalizing the medical power of attorney template, you should print and sign it. State law requires that you sign the document before at least two adult witnesses. The witnesses should confirm that you are of legal age, of sound mind, and that you are voluntarily signing the document.

#5. Notarize the Form

Although not required by state law, you should consider signing the medical power of attorney before a notary. This will provide additional security for all the parties involved, confirm the document’s authenticity, and prevent fraud.