Missouri Medical Power of Attorney Form [PDF]

Authorize another person to make healthcare decisions on your behalf by drafting the Missouri medical power of attorney using our template.

Last update: 27 Mar 2024

Missouri Medical Power of Attorney Form [PDF]

A Missouri medical power of attorney, or a healthcare power of attorney, is a legal document that gives authority to the agent or attorney-in-fact to make healthcare decisions on behalf of the principal according to their healthcare preferences outlined in the power of attorney.

The medical power of attorney can include all the principal’s healthcare preferences regarding life-sustaining treatment, artificial nutrition and hydration, certain medical treatments, or medications.

The principal issues a medical power of attorney when they are facing serious surgery, have been diagnosed with a terminal illness, or there is a high possibility they won’t be able to make healthcare decisions for themselves.

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

Laws and Legal Requirements

Title XXVI, Chapter 404, Sections 404.800 to 404.865 of the Missouri Revised Statutes regulate the status of medical power of attorney in Missouri.

§ 404.705(3) provides that the principal must sign the medical power of attorney form in the presence of a notary public.

§ 404.850 provides that you can revoke the medical POA by communicating your revocation to your agent or a healthcare provider.

How to Write a Medical Power of Attorney in Missouri

In Missouri, the easiest way to draft and issue a medical power of attorney is by following 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 can find the medical power of attorney template. You can fill it out by completing the relevant questions designed by our legal document builder. This will make drafting the medical power of attorney fast and easy.

First, you should provide basic information about the principal, such as their full name, mailing address, and contact details. You should also provide the date of issuing the document.

#2. Appoint a Healthcare Representative

This is your agent or the attorney-in-fact. The healthcare representative should be an adult with the legal capacity to act. 

Moreover, considering the importance of their authority in this situation, you should choose someone you trust. This can be your spouse, a blood relative, a friend, or another trusted advisor.

In this section, you can enter their full name, mailing address, and contact details. Moreover, you can provide the medical power of attorney rights and limitations and define the scope of your agent’s authority.

#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. Provide the Agent’s Scope of Authority

Once you have named your agent, you should define their scope of authority by providing their medical power of attorney rights and limitations.

Here, you can provide your preferences on what medical treatment you want or don’t want to be subjected to. You can also include your end-to-life and organ donation preferences. Your agent will, therefore, be able to act only according to your preferences outlined in the document.

#5. Notarize the Form

Finally, you should sign your document in front of a notary public. The notary public will confirm your identity and acknowledge that you have signed the document willingly and that you were of sound mind at the time of signing the document.

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