North Dakota Medical Power of Attorney Form [PDF]

Outline your healthcare preferences by drafting the North Dakota medical power of attorney using our advanced and customizable template.

Last update: 27 Mar 2024

North Dakota Medical Power of Attorney Form [PDF]

The North Dakota medical power of attorney, or healthcare power of attorney, is a legal document that enables one person, called the principal, to authorize another person, called the agent or the attorney-in-fact, to make decisions about their healthcare if they cannot do so.

This can happen if the principal loses legal capacity or is, in another way, unable to notify the healthcare practitioner about their medical preferences. The principal can use the medical power of attorney to outline their preferences regarding the medication or medical treatment they want or don’t want to be subjected to.

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

Laws and Legal Requirements

Chapter 23-06.5-01-19 of the North Dakota Code regulates the status of medical power of attorney in North Dakota.

Section 23-06.5-05 provides that the principal must sign the medical power of attorney form before at least two witnesses or a notary public.

Section 23-06.5-07 provides that the principal can revoke the medical power of attorney by:

  • Notifying the agent or healthcare provider orally or in writing

  • Issuing a new medical power of attorney

  • Showing an act of specific intent that they want to revoke the medical POA

How to Write a Medical Power of Attorney in North Dakota

This section will present the step-by-step process of drafting the medical power of attorney that is in line with all the state laws and regulations in North Dakota.

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. All you have to do is fill it out according to the instructions provided by our advanced legal document builder.

The first step is to fill out the basic information about the document and principal, such as:

  • Date of issuing the medical power of attorney form

  • Full name, mailing address, and contact details of the principal

#2. Appoint a Healthcare Representative

In this step, you should provide the full name, mailing address, and contact details of the person you want to appoint as your healthcare representative. The healthcare representative is also referred to as the agent or the attorney-in-fact.

You should choose someone who is of legal age and has the legal capacity to represent you. Moreover, you should choose someone trustworthy, considering the importance of the matter your agent will have authority over. 

Here, you can also specify the scope of your healthcare representative's authority as well as the rights and restrictions associated with the medical power of attorney.

#3. Identify an Alternative Healthcare Representative

Here, you should appoint a person who will represent you in case the primary agent is not able to represent you. This can happen if the primary agent loses legal capacity, passes away, or is not physically available to represent you.

The alternative healthcare representative is also called the secondary agent or the secondary attorney-in-fact. They should fulfill the same requirements as the primary agent. You can appoint one or more secondary agents to represent you.

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

After finalizing the document, you should print and sign it. You must sign the document before at least two witnesses who are at least 18 years old.

One of the witnesses can be a health care or long-term care provider or an employee. None of the witnesses can be the principal’s spouse or heir, a person related to the principal by blood, marriage, or adoption, or a person entitled to any part of the estate of the principal.

#5. Notarize the Form

Alternatively, you can sign the medical power of attorney form before the notary public. The notary public will acknowledge that you have personally signed the document, which will confirm its authenticity.

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