Pennsylvania Medical Power of Attorney Form [PDF]

Authorize someone to make decisions about your healthcare by creating a Pennsylvania medical power of attorney using our template.

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Pennsylvania
Customized for PennsylvaniaThis document may be legally binding in Pennsylvania according to your state specific regulations.
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  • Last reviewed on April 27th
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The Pennsylvania 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 represent them before the healthcare institution and make healthcare decisions on their behalf.

The principal should issue a medical power of attorney if they are of unstable physical or mental health, and there is a possibility that they might not be able to make decisions about their healthcare in the future.

The principal will then use the medical power of attorney form to outline their preferences about the medical treatments and medications they want or don’t want to be subjected to.

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

Laws and Legal Requirements

Title 20, Chapter 54, Subchapter C of the Pennsylvania Consolidated Statutes regulates the status of medical power of attorney in Pennsylvania. 

Section 5452 regulates the signature requirements. It stipulates that there must be at least two witnesses who sign the medical power of attorney. However, the notarization of the document is not mandatory.

Section 5459 provides that the principal can revoke the medical power of attorney by issuing a medical power of attorney revocation or by notifying their doctor or a healthcare provider.

How to Write a Medical Power of Attorney in Pennsylvania

Here, you can see the step-by-step process of writing the Pennsylvania medical power of attorney.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you will find the Pennsylvania medical power of attorney template. You should fill it out with relevant information about you and the agent and outline your preferences about the healthcare treatment you want or don’t want to be subjected to.

Our professional document builder will walk you through the whole process by providing all the relevant information on how to fill out the template.

First, you should provide basic information about the principal by providing their full name, mailing address, and contact details, as well as the date of issuing the medical power of attorney.

#2. Appoint a Healthcare Representative

The healthcare representative is also referred to as the agent or the attorney-in-fact. They will be the main person in charge of representing you before the healthcare institution and ensuring your healthcare preferences are respected.

You should enter their full name, mailing address, and contact details in the medical POA form. The healthcare representative should be an adult and have the legal capacity to represent you. Moreover, considering the importance of their authority, you should appoint someone you can trust.

Here, you can specify medical power of attorney rights and limitations and define your agent’s scope of authority.

#3. Identify an Alternative Healthcare Representative

This is the person who can act only in case the primary healthcare representative loses legal capacity or is, in some other way, unable to represent the principal. They are also called the secondary agent or the secondary attorney-in-law.

The alternative healthcare representative should meet the same requirements in terms of age and legal capacity as the primary healthcare representative. You can appoint one or more people to act as your secondary healthcare representatives.

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

After finalizing your medical power of attorney form, you should print and sign it. The state law provides that the document must be signed by at least two witnesses who are at least 18 years old.

#5. Notarize the Form

Furthermore, you have the option to sign the medical power of attorney in front of a notary public. This will provide additional authenticity for the document and prevent potential fraud.

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