Free Medical Power of Attorney (MPOA) Forms [PDF Download]

One can never know if and when some unexpected illness or injury will happen to them. The medical power of attorney can secure the principal in situations where they need medical attention or treatment but are not able to represent themselves. This can happen due to the state of unconsciousness, old age, or some kind of disability.

By creating a medical power of attorney, the principal authorizes another person to represent their interests, outline their health preferences, and set the scope of authority for their agent.

What is a Medical Power of Attorney?

The medical power of attorney (MPOA) is a legal document that the principal uses to authorize another person to represent them before the healthcare provider and make sure they are treated according to their healthcare preferences.

The person needs someone else to represent their interests and make medical decisions on their behalf when they are unable to make such decisions themselves. This can happen if they lose legal capacity, are in a critical medical condition, or don’t have consciousness due to an injury or illness.

Medical POA vs. Living Will

The main purpose of the living will is to outline the preferences of the person issuing the document regarding their life-prolonging medical treatment. They will use the living will to outline if they want to be kept on life support, if they want to die naturally, or if they want or don’t want to be subjected to certain treatments.

With a medical power of attorney sample, the principal uses the document to authorize another person to represent their interests and make decisions about their healthcare on their behalf.

Medical POA vs. General Power of Attorney

The main difference between the medical and general power of attorney is in the scope of authority. With the medical power of attorney, the principal only authorizes their agent to make decisions about their healthcare.

However, with the general power of attorney, the scope of authority is much wider since the principal can authorize their agent to complete any action on their behalf.

Medical POA vs. Durable Power of Attorney

The durable power of attorney enables the agent to make financial, legal, and business decisions on behalf of the principal. The term durable indicates that the agent will have the authority indicated in the power of attorney even if the principal loses legal capacity.

In this sense, the medical power of attorney sample can also be considered durable since it also remains valid in cases of the principal’s incapacity. However, unlike the durable power of attorney, the medical power of attorney authorizes the agent to only make decisions about the principal’s healthcare.

Medical Power of Attorney Form by States

Statutory Medical POA Forms

STATE	STATUTORY FORM	LAW
Alabama	Advance Directive for Health Care	Ala. Code § 22-8A-4
Alaska	Advance Health Care Directive	Alaska Stat. § 13.52.010
Arizona	Health Care Power of Attorney	§ 36-3224
Arkansas	Durable Power of Attorney for Health Care	Ark. Code § 20-6-103
California	Advance Health Care Directive	§ 4701
Colorado	Medical Durable Power of Attorney	Colo. Rev. Stat. § 15-14-506
Connecticut	Appointment of Health Care Representative	Sec. 19a-575a
Delaware	Advance Health Care Directive	§ 2505
Florida	Designation of Health Care Surrogate	§ 765.202(1)
Georgia	Advance Directive for Health Care	§ 31-32-4
Hawaii	Advance Health Care Directive Form	Haw. Rev. Stat. § 327E-16
Idaho	Advance Care Planning Document	§ 39-4510
Illinois	Durable Power of Attorney for Health Care	755 ILCS 35/3(b)
Indiana	Indiana Power of Attorney for Health Care Decisions	Ind. Code § 16-36-7-28
Iowa	Durable Power of Attorney for Health Care Decisions	§ 144B.5
Kansas	Durable Power of Attorney for Healthcare Decisions	§ 58-632
Kentucky	Advance Directive	§ 311.629
Louisiana	Health Care Power of Attorney	RS 28:223
Maine	Power of Attorney for Health Care	§5-805
Maryland	Advance Directive	§ 5-603
Massachusetts	Health Care Proxy	§ 201D-2
Michigan	Durable Power of Attorney for Health Care	§ 700.5501(b)
Minnesota	Health Care Directive	§ 145C.16
Mississippi	Advance Health-Care Directive	§ 41-41-209
Missouri	Durable Power of Attorney for Health Care	§ 404.822
Montana	Durable Power of Attorney for Health Care	§ 53-21-1304
Nebraska	Power of Attorney for Health Care	§ 30-3404
Nevada	Durable Power of Attorney for Healthcare Decisions	NRS 162A.860
New Hampshire	Advance Directive	§ 137-J:20
New Jersey	Durable Power of Attorney for Health Care	N.J. Stat. § 26:2H-57
New Mexico	Advance Directive for New Mexico	§ 24-7A-4
New York	Health Care Proxy	PBH § 2981
North Carolina	Health Care Power of Attorney	§ 90-321
North Dakota	Health Care Directive	§ 23-06.5-17
Ohio	Health Care Power of Attorney	Section 1337.17
Oklahoma	Advance Directive for Health Care	§ 63-3101.4
Oregon	Advance Directive for Health Care	ORS 127.527
Pennsylvania	Durable Health Care Power of Attorney	§ 5471
Rhode Island	Durable Power of Attorney for Healthcare	§ 23-4.10-2
South Carolina	Health Care Power of Attorney	§ 62-5-504
South Dakota	Durable Power of Attorney for Health Care	§ 59-7-2.1
Tennessee	Advance Directive for Health Care	§ 68-11-1803(b)
Texas	Durable Power of Attorney for Health Care	§ 166.164
Utah	Advance Health Care Directive	§ 75-2a-117
Vermont	Advance Directive for Health Care	18 V.S.A. § 9703
Virginia	Advance Medical Directive	§ 54.1-2984
Washington	Durable Power of Attorney for Health Care	§ 11.125.100
West Virginia	Medical Power of Attorney	§ 16-30-4
Wisconsin	Power of Attorney for Health Care	§ 155.30
Wyoming	Advance Health Care Directive	§ 35-22-403

Medical Power of Attorney Signing Requirements

STATE	SIGNING REQUIREMENTS	LAW
Alabama	Two witnesses	§ 22-8A-4(c)(4)
Alaska	Two witnesses or notary public	§ 13.52.010(b)
Arizona	One witness or notary public	§ 36-3221(A)(3)
Arkansas	Two witnesses or notary public	§ 20-6-103(c)
California	Two witnesses or notary public	§ 4701
Colorado	No law	N/A
Connecticut	Two witnesses	§ 19a-575
Delaware	Two witnesses	§ 2503(b)(1)(d)
Florida	Two witnesses	§ 765.202(1)
Georgia	Two witnesses	§ 31-32-5(c)(1)
Hawaii	Two witnesses or notary public	§ 327E-3(b)
Idaho	No law	N/A
Illinois	One witness	755 ILCS 45/4-5.1
Indiana	Two witnesses or notary public	§ 16-36-7-28(b)(1)
Iowa	Two witnesses or notary public	§ 144B.3(b)
Kansas	Two witnesses and a notary public	§ 58-632
Kentucky	Two witnesses or notary public	§ 311.625(2)
Louisiana	Two witnesses	§ 224 (A)
Maine	Two witnesses	§ 5-803(2)
Maryland	Two witnesses	§ 5–603
Massachusetts	Two witnesses	§ 201D-2
Michigan	Two witnesses	§ 700.5506(4)
Minnesota	Two witnesses or notary public	§ 145C.03(5)
Mississippi	Two witnesses or notary public	§ 41-41-205(2)
Missouri	Notary public	§ 404.705(3)
Montana	Two witnesses	§ 50-9-103
Nebraska	Two witnesses or notary public	§ 30-3404(5)
Nevada	Two witnesses or notary public	§ 162A.790
New Hampshire	Two witnesses or notary public	§ 137-J:14
New Jersey	Two witnesses or notary public	§ 26:2H-56
New Mexico	Two witnesses	§ 24-7A-4
New York	Two witnesses	§ 2981(2)
North Carolina	Two witnesses and a notary public	§ 32A-16(3)
North Dakota	Two witnesses or notary public	§ 23-06.5-05(1)(e)
Ohio	Two witnesses or notary public	§ 1337.12
Oklahoma	Two witnesses	63 O.S. § 3101.4(A)
Oregon	Two witnesses or notary public	§ 127.515(2)
Pennsylvania	Two witnesses	§ 5452(b)(2)
Rhode Island	Two witnesses or notary public	§ 23-4.10-2
South Carolina	Two witnesses and a notary public	§ 62-5-517
South Dakota	Two witnesses or notary public	§ 34-12D-2
Tennessee	Two witnesses or notary public	§ 34-6-203(a)(3)
Texas	Two witnesses or notary public	§ 166.154
Utah	One witness	§ 75-2a-107(c)
Vermont	Two witnesses	§ 9703(b)
Virginia	Two witnesses	§ 54.1-2983
Washington	Two witnesses or notary public	§ 70.122.030
West Virginia	Two witnesses and a notary public	§ 16-30-4(a)
Wisconsin	Two witnesses	§ 155.10(1)(c)
Wyoming	Two witnesses or notary public	§ 35-22-403(b)

Medical Power of Attorney Agent Powers

By issuing a medical power of attorney (MPOA), the principal grants certain powers to their agent. The principal can give their agent broad authority to represent their interests and make decisions in all matters regarding their healthcare, or they can name specific authorities that they might have.

Here, we will present the most common powers that a healthcare agent can have:

Powers of a Healthcare Agent

Accessing the principal's medical record and information. This means that the agent will be authorized to get any information about the principal’s medical status and access any medical or hospital records of the principal.
Authorizing the principal's admission or discharge from a hospital, long-term care facility, nursing home, convalescent home, or other health care facility.
Employing or discharging any healthcare provider of the principal. Here, the agent will have the authority to choose the healthcare professional who will provide treatment for the agent or to dismiss them.
Giving or withholding consent to certain medical treatments. This can include X-rays, anesthesia, surgery, and all other diagnostic and treatment procedures.
Giving or withholding consent to certain medications. This especially includes consent for any pain-relieving medications.
Giving or withholding consent to certain life-prolonging measures. This can include decisions about life-sustaining treatment, resuscitation, and palliative care.
Giving consent to organ donation.

Why Should You Get a Medical Power of Attorney Form?

There are multiple advantages to having a medical power of attorney form. However, the benefits for each person can be different depending on their medical condition, family relationship, healthcare preferences, and more.

In this section, you will see some of the most common benefits of the medical power of attorney:

Advantages of The Medical Power of Attorney Form

Ensuring that the principal’s healthcare preferences are honored. One of the greatest benefits of a medical power of attorney form is that the principal can use it to list all of their medical preferences and name a person who will make sure their preferences are honored in case the principal can’t communicate.
Avoiding family conflicts over medical decisions. By outlining their healthcare preferences, the principal will prevent potential disputes between the family members on what medication or medical treatment the principal should or shouldn’t be subjected to.
Providing clear guidance to healthcare providers. The document will also provide a framework for healthcare providers by listing the treatments and medications they want or don’t want to be subjected to.
Ensuring more efficient medical care. By authorizing someone to make medical decisions on their behalf in case they cannot communicate, the principal will secure efficient medical treatment in urgent situations.
Ease the burden of making medical decisions for loved ones. In this way, the principal will give clear guidelines about their healthcare preferences, and the family members won’t have the burden of making important healthcare decisions. This is especially important for life-sustaining preferences.

When Should You Get a Medical Power of Attorney Form?

You should get the medical power of attorney form when your physical or mental health becomes unstable or when you are uncertain whether you will be able to make your own medical decision in the near future.

However, such inability can happen even with perfectly healthy people due to certain accidents. Therefore, the safest option is always to have the medical power of attorney as soon as you turn 18, and your parents lose the right to make healthcare decisions on your behalf.

The list below outlines all the situations where a medical power of attorney (MPOA) should be issued:

The Appropriate Places to Grant a Medical Power of Attorney

Facing a serious medical procedure. The principal should always issue a medical POA if they are about to have serious surgery that can potentially make them unable to make medical decisions personally.
After being diagnosed with certain illnesses. In this situation, the principal should issue the medical power of attorney to protect themselves if their condition worsens and they are unable to make decisions for themselves.
Reaching a certain age. It is good to issue a medical power of attorney as soon as you reach the age of 18. However, if you reach old age, it is especially important to have such documents, as the possibility of not being able to make your own medical decisions increases.
Engaging in risky activities. If you are working in a line of work with a high possibility of injuries and accidents, you should outline your healthcare preferences by issuing a medical power of attorney.
During pregnancy. As this is a particularly sensitive period for a woman’s health, it is important to have a medical power of attorney prepared in case of complications during or after pregnancy.
Experiencing cognitive decline or dementia. People with cognitive decline have a high risk of losing their legal capacity, and therefore, it is important that their healthcare preferences are protected through the medical power of attorney form.

How to Get a Medical Power of Attorney

The easiest way to get a professional medical power of attorney template that is in line with all the laws and legal requirements for this kind of document is to use our advanced power of attorney builder.

Here, you will see the step-by-step process of how to draft the medical power of attorney using our legal document builder.

Checklist to get a Medical Power of Attorney

#1. Choose Your Healthcare Agent

The first step is to select a person that you want to authorize to represent you before your healthcare providers and make medical decisions on your behalf.

You should enter their full name and mailing address in the power of attorney form.

When choosing a healthcare agent, you should look for someone who is of legal age and has the legal capacity to represent you. Moreover, you should look for someone you can trust, considering that they will have important authority over your healthcare.

In this section, you can also name the secondary agent. Their role is to represent you in case the primary agent loses their legal capacity or is, in some other way, unable to represent you.

#2. Define Your Healthcare Agent’s Authority

After naming your agent, you should define the scope of their authority by providing a list of activities they can conduct on your behalf.

You can authorize them to:

Have access to all of your medical records
Make decisions regarding your healthcare treatment
Decide what medications you will be subjected to according to your preferences outlined in the document
Decide if you will be subjected to any life-sustaining treatments
Choose and dismiss the healthcare providers

#3. Include Your Living Will

Here, you can provide all the details about what treatments and medications you want or don’t want to be subjected to.

This can include your preferences on artificial hydration and nutrition, mechanical ventilation, end-of-life care preferences, autopsy, organ donation, and more.

This will serve as a guideline for all healthcare providers, as well as your healthcare agent when deciding on your healthcare treatment.

#4. Sign the Medical POA Form

Depending on the requirements of the specific state you are using your medical power of attorney template in, there will be different signing requirements for the document.

Some states only require the principal to sign the medical power of attorney. However, most states require one or more witnesses or a notary public to acknowledge that the principal has signed a power of attorney by adding their signature to the document.

How to Revoke a Medical Power of Attorney

In case you want to revoke your medical power of attorney, change your agent, or add or remove some of the authorities your agent can have, you can simply issue a revocation power of attorney.

Another way is to issue another power of attorney, where you will indicate that the new power of attorney puts out of force the previously issued one. It will be good to name which power of attorney, in particular, you want to put out of force by specifying the date of issuance of the previous one.

The revocation or new power of attorney should fulfill all the formal requirements. This means that it must be in writing and, depending on the state, must also have one or more witnesses and, in some states, a notary public’s signature.

Medical Power of Attorney FAQ

If you don’t have a medical power of attorney and you become incapacitated or, in other ways, unable to make your own medical decisions, the healthcare provider will usually call some of your family members to make a healthcare decision on your behalf.
However, this can potentially cause issues if there are multiple family members and if they don’t agree on what medical treatment you should or shouldn’t be subjected to.
No, the spouse does not automatically have a medical power of attorney. The spouse might be called upon to make medical decisions on your behalf if there is no medical power of attorney. However, this is not guaranteed.
The best way to make sure your spouse will have the authority to make medical decisions on your behalf is to name them as your agent in the medical power of attorney.
A person who can be appointed as a healthcare agent for a medical power of attorney must be of legal age and have the legal capacity to act on your behalf. Moreover, it should be someone who is willing to represent you and someone you can trust.
The medical power of attorney will take effect once the principal loses the legal capacity or becomes, in some other way, unable to make medical decisions themselves. In some cases, the attending physician must officially determine that the principal is not able to make their medical decisions.
The medical power of attorney is valid until the principal passes away or if some of the following conditions are met:
If the principal revokes their medical power of attorney
If the medical power of attorney expires (in the event that the expiration date is indicated in the document)
If the agent becomes incapacitated and there is no subsidiary agent
Yes, you can have more than one medical power of attorney as long as they do not create a collision of authority between the agents.
In practice, this means that you can authorize one agent to make decisions regarding certain matters and authorize another agent to decide about different matters regarding your healthcare, but their authorities should not overlap.
Yes, most of the states require the notarization of the medical power of attorney.
If you are issuing a medical power of attorney in Alaska, Arizona, Arkansas, California, Hawaii, Indiana, Iowa, Kansas, Kentucky, Minnesota, Mississippi, Missouri, Nebraska, Nevada, New Hampshire, New Jersey, North Carolina, North Dakota, Ohio, Oregon, Rhode Island, South Carolina, South Dakota, Tennessee, Texas, Washington, West Virginia, and Wyoming, you will be required to notarize your medical power of attorney.