North Carolina Medical Power of Attorney Form [PDF]

Appoint someone to make important healthcare decisions on your behalf by drafting the North Carolina medical power of attorney.

Last update: 26 Mar 2024

North Carolina Medical Power of Attorney Form [PDF]

The North Carolina power of attorney, or healthcare power of attorney, is a legal document that gives your agent or the attorney-in-fact the authority to make healthcare decisions on your behalf in case you lose your legal capacity or become in some other way unable to make your own healthcare decisions.

The person issuing the medical power of attorney is called the principal. The principal usually issues the medical power of attorney if they are facing serious surgery or if they have been diagnosed with a terminal illness. 

The principal will use this document to outline their preferences regarding the medication or treatment they want or don’t want to be subjected to.

Laws and Legal Requirements for a Medical Power of Attorney in North Carolina

Laws and Legal Requirements

Chapter 32A, Article 3 of the North Carolina General Statutes regulates the status of medical power of attorney in North Carolina. 

Section 32A-16(3) provides that the medical power of attorney must be acknowledged by at least two witnesses and a notary public to be valid and effective.

Section 32A-20 provides that the medical power of attorney can be revoked when the principal issues a medical power of attorney revocation, issues a new medical power of attorney or notifies their attending physician that they wish to revoke the medical POA.

How to Write a Medical Power of Attorney in North Carolina

To make a valid and effective medical power of attorney that’s in accordance with North Carolina state laws and regulations, you should follow the steps outlined in the section 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 relevant questions with the guidance of our advanced document builder.

The first step is to fill out the basic information, such as:

  • Name, address, and contact details of the principal

  • Date of issuing the power of attorney

#2. Appoint a Healthcare Representative

The healthcare representative is also referred to as the agent or the attorney-in-fact. A healthcare representative is a person authorized to make healthcare decisions on behalf of the principal. The medical power of attorney form should include their full name, mailing address, and contact details.

The healthcare representative should be someone of legal age with the legal capacity to act. Moreover, considering the importance of the matter they have authority over, you should choose someone you can trust. 

This is also where you can specify the rights and restrictions of a medical power of attorney and define the authority of your agent.

#3. Identify an Alternative Healthcare Representative

This is the person who will act only in case the primary healthcare representative loses legal capacity or becomes, in some way, unable to represent you. The alternative healthcare representative is also called the secondary agent or secondary attorney-in-fact.

The alternative healthcare representative should fulfill the same requirements as the primary one. You can name one or more people to act as your alternative healthcare representatives.

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

After you have finalized your document, you should print and sign it. North Carolina state law requires you to sign the document before at least two witnesses. The witnesses must be of legal age and have the legal capacity to act.

The witnesses will confirm that you have personally and freely signed the medical power of attorney by putting their signature next to yours.

#5. Notarize the Form

The notary public must also sign the document. The notary public will identify you, and the witnesses will acknowledge that you have signed the medical power of attorney. This will additionally confirm the document's authenticity and prevent potential misunderstandings and fraudulent activities.

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