New Hampshire Medical Power of Attorney Form [PDF]

Read our comprehensive guide on appointing someone as your healthcare representative using a New Hampshire medical power of attorney.

Last update: 27 Mar 2024

New Hampshire Medical Power of Attorney Form [PDF]

The New Hampshire medical power of attorney, or healthcare power of attorney, is a legal document that one person, called the principal, issues with the goal of authorizing another person, called the agent or attorney-in-fact, to act on their behalf and make decisions about their healthcare.

The principal usually issues the medical power of attorney when they are in bad physical or mental health, are facing serious surgery, or have been diagnosed with a terminal illness. 

In the document, they will outline all their preferences regarding the treatments and medication they want or don’t want to be subjected to.

Laws and Legal Requirements for a Medical Power of Attorney in New Hampshire

Laws and Legal Requirements

Chapter 137-J of the New Hampshire Revised Statutes regulates the status of the New Hampshire medical power of attorney.

Section 137-J:14 provides that the principal must sign the medical power of attorney before at least two witnesses or a notary public.

According to Section 137-J:15, the following actions can revoke the medical power of attorney:

  • Written revocation delivered to the agent or the healthcare provider

  • Oral revocation made in front of two witnesses

  • An act in a manner to prove intent to revoke

  • Execution of another medical power of attorney

How to Write a Medical Power of Attorney in New Hampshire

In New Hampshire, the easiest way to create a valid and effective medical power of attorney is by following the steps outlined below:

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find a specially drafted New Hampshire medical power of attorney template. All you have to do is fill it out according to the instructions provided by our professional document builder.

First, you should enter some basic details, like the full name, mailing address, and contact details of the principal, as well as the date of issuing the medical power of attorney.

#2. Appoint a Healthcare Representative

This person is also called the agent or the attorney-in-fact. They should be of legal age and have the legal capacity to act. Moreover, considering the importance of their authority, the healthcare representative should be someone you can trust. You can appoint your spouse, a blood relative, a friend, or another trusted advisor.

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

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative, or secondary agent, is a person who acts only in cases where the primary agent is not able to act. This can happen if the primary agent loses legal capacity, passes away, or is, in some other way, unable to represent the principal.

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

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

Once you have finalized the medical power of attorney form, you should print and sign it. State law requires that you sign the document before at least two witnesses. The witness should be an adult with the legal capacity to act.

The following categories of people are not allowed to be witnesses:

  • The principal's agent or surrogate

  • The principal's spouse or heir-at-law

  • A person entitled to any part of the principal’s estate

  • The principal's attending practitioner

#5. Notarize the Form

Alternatively, you can sign the medical power of attorney before a notary public. They will confirm your identity and acknowledge that you have signed the medical power of attorney as the principal. In this way, the notary public will provide additional authenticity for the document and prevent potential misunderstandings, disputes, and fraudulent activities.

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