Rhode Island Medical Power of Attorney Form [PDF]

Read our guide on authorizing someone to make healthcare decisions for you by creating the Rhode Island medical power of attorney.

Rhode Island
Customized for Rhode IslandThis document may be legally binding in Rhode Island according to your state specific regulations.
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  • Last reviewed on April 27th

A Rhode Island medical power of attorney, also known as a healthcare power of attorney, is a legal document that gives one individual, known as the principal, the authority to designate another individual, known as the agent or attorney-in-fact, to represent their interests in front of the healthcare facility and make decisions regarding their care on their behalf.

The healthcare power of attorney should be issued in the following situations:

When to Issue a Healthcare Power of Attorney

  • If the principal is of old age and wants to authorize someone to be able to make general decisions regarding their healthcare and treatment

  • If the principal is diagnosed with a terminal condition

  • If the principal is facing a possible surgery

  • If the principal wants to authorize someone to make end-of-life decisions on their behalf

Laws and Legal Requirements for a Medical Power of Attorney in Rhode Island

Laws and Legal Requirements

Title 23, Chapter 23-4.10 of the Rhode Island General Laws regulates the status of the medical power of attorney form in Rhode Island.

According to Section 23-4.10-2, the principal must sign the medical power of attorney, and at least two witnesses or a notary public must acknowledge it.

Section 23-4.10-3 provides that the principal can revoke the medical power of attorney at any time as long as they can communicate their desire to revoke the document.

How to Write a Medical Power of Attorney in Rhode Island

To draft a valid medical power of attorney in Rhode Island, you should 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 effective and valid

Our sophisticated legal document builder will walk you through every step of the procedure by showing you how to complete each template field.

First, you should provide the basic details, such as the date of issuing the medical power of attorney and the principal’s full name, mailing address, and contact details.

#2. Appoint a Healthcare Representative

In this section, you should enter the full name, mailing address, and contact details of the person you want to appoint as your healthcare representative. They are also referred to as the agent or attorney-in-fact.

The healthcare representative must be of legal age and have the legal capacity to represent you. Moreover, considering the importance of the matter they will have authority over, you should appoint someone trustworthy. That can be your spouse, a relative, a friend, or another person you trust.

Here, you can also specify the rights and restrictions associated with the medical power of attorney as well as the extent of your agent's power.

#3. Identify an Alternative Healthcare Representative

The alternative healthcare representative is also referred to as the secondary agent or secondary attorney-in-fact. They can act in case the primary agent loses legal capacity, passes away, or is, in some other way, unable to represent you.

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

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

After finalizing your document, you should sign it before at least two qualified witnesses or a notary public.

Witnesses cannot be the following persons:

  • The principal's primary or secondary agent

  • The principal's healthcare provider or their employee

  • The operator of a community care facility or their employee

#5. Notarize the Form

Alternatively, the document can be acknowledged by the notary public. The notary public will identify the principal and confirm that they have personally signed the document. This will confirm the authenticity of the document and prevent potential fraudulent activities.

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