Utah Medical Power of Attorney Form [PDF]

Secure your healthcare preferences by drafting the Utah medical power of attorney using our customizable medical power of attorney templates.

Last update: 26 Mar 2024

Utah Medical Power of Attorney Form [PDF]

The Utah power of attorney, or healthcare power of attorney, is a legal document that enables one party, called the principal, to authorize another party, called the agent or attorney-in-fact, to represent them and make healthcare decisions on their behalf

The principal issues a medical power of attorney if they are facing a life-threatening surgery or have been diagnosed with a terminal illness. By issuing the medical power of attorney, they will appoint someone who will make sure the principal is receiving the treatment they want.

The principal will outline all the treatments or medications they want or don’t want to be subjected to. The document can also include the principal’s end-to-life preferences and preferences about artificial nutrition or hydration.

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

Title 75, Chapter 2A, of the Utah Code, also called the Advance Health Care Directive Act, regulates the status of medical power of attorney in Utah.

Section 75-2a-107(c) provides that the medical power of attorney should be signed before at least one disinterested witness.

Section 75-2a-114 provides that the principal can revoke the medical power of attorney by notifying someone 18 years of age or older who is not a relative, beneficiary, healthcare provider, or an adult who will become an agent under a new Advance Healthcare Directive by writing “void” on the document, by issuing a new document, or by destroying the document.

How to Write a Medical Power of Attorney in Utah

To make a valid and effective medical power of attorney that’s in line with Utah 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 Utah medical power of attorney form. You can fill it out by completing the relevant questions with the guidance of our advanced legal document builder. The builder will then create a printable and downloadable medical power of attorney based on your input.

The date the medical power of attorney form was issued, along with the principal's full name, mailing address, and phone number, should go in first.

#2. Appoint a Healthcare Representative

Here, you should enter the full name, mailing address, and contact details of the person you want to appoint as your healthcare representative (also called the agent or the attorney-in-fact). 

The healthcare representative should be at least 18 years of age and have the legal capacity to act.

Moreover, you should find someone you can trust, considering the importance of the matter your healthcare representative will have authority over. You can appoint your spouse, a relative, a friend, or another trusted individual. 

Here’s where you should include medical power of attorney rights and limitations and define your agent’s scope of authority.

#3. Identify an Alternative Healthcare Representative

An alternative healthcare representative is a person that you can appoint to make healthcare decisions on your behalf in case the primary healthcare representative is unable to do so

That can happen if the primary healthcare representative passes away, loses legal capacity, or is, in some other way, unable to represent you.

The alternative healthcare representative is also referred to as the secondary agent or secondary attorney-in-fact.

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

After finalizing the document, you should sign it before at least one qualified witness. Section 75-2a-107(c) provides what categories of people are not eligible to sign the document as a witness.

#5. Notarize the Form

Although not required by state law, you can also confirm the authenticity of the document by signing it in front of the notary public. The acknowledgment of the notary public will provide additional security for all the parties involved and prevent potential fraudulent activities.

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