Nebraska Medical Power of Attorney Form [PDF]

Authorize someone to make healthcare decisions on your behalf by issuing the Nebraska medical power of attorney using our template.

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Nebraska
Customized for NebraskaThis document may be legally binding in Nebraska according to your state specific regulations.
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  • Last reviewed on April 27th
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The Nebraska medical power of attorney, or healthcare power of attorney, is a legal document that one person, called the principal, uses to authorize another person, called the agent or the attorney in fact, to represent them and make healthcare decisions on their behalf.

The medical power of attorney will include the basic details about the principal, agent, and secondary agent and provide instructions on what actions the agent can take on behalf of the principal.

A medical power of attorney should be issued if the principal is diagnosed with a terminal illness or is about to undergo a life-threatening medical procedure.

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

Laws and Legal Requirements

Chapter 30, Sections 3401 to 3432 of the Nebraska Revised Statutes regulate the status of medical power of attorney in Nebraska.

According to Section 30-3404, the principal and at least two witnesses, or a notary public, must sign the medical power of attorney.

Section 30-3420 provides that you can revoke your medical power of attorney by notifying your attending physician, your healthcare provider, or your agent.

How to Write a Medical Power of Attorney in Nebraska

To draft a valid and enforceable medical power of attorney in Nebraska, 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 can find the medical power of attorney template, which will include all the information needed for the document to be valid and effective. The advanced document builder will lead you through the drafting process by providing relevant information on each step.

First, you should enter the principal’s full name, mailing address, and contact details.

#2. Appoint a Healthcare Representative

A healthcare representative, also called an agent or attorney-in-fact, is a person who represents your interests and makes healthcare decisions on your behalf. In this form, you should appoint them by entering their full names, mailing addresses, and contact details.

The healthcare representative should be of legal age and have the legal capacity to represent you. Moreover, it should be someone you can trust since they will have important authority over your healthcare. 

Here, you can also provide medical power of attorney rights and limitations and determine your agent’s scope of authority.

#3. Identify an Alternative Healthcare Representative

An alternative healthcare representative is also called a secondary agent or a secondary attorney-in-fact. 

They usually have the same authority as the primary healthcare representative, but they can exercise it only if the primary healthcare representative is not able to act. This can happen if they lose their legal capacity, pass away, or are physically unable to act.

The secondary agent should fulfill the same requirements as the primary agent regarding legal capacity, age, and trustworthiness.

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

Once you have completed the medical power of attorney form, you should print and sign it. State law requires you to sign the document before at least two witnesses.

A witness must be an adult with the legal capacity to act. The witness cannot be a person who is appointed as an agent or a successor agent.

#5. Notarize the Form

Alternatively, instead of providing two witnesses, you can sign the document before a notary public. The notary public will determine your identity and acknowledge that you have personally signed the document. This will additionally confirm the authenticity of the document and prevent potential misunderstandings and fraudulent activities.

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