West Virginia Medical Power of Attorney Form [PDF]

Authorize someone to make healthcare decisions if you become unable to do so by drafting the West Virginia medical power of attorney.

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West Virginia
Customized for West VirginiaThis document may be legally binding in West Virginia according to your state specific regulations.
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  • Last reviewed on April 27th
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The West Virginia medical power of attorney, or healthcare power of attorney, is a legal document that one person, called the principal, uses to authorize another person, called the agent or attorney-in-fact, to make medical decisions 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 West Virginia

Chapter 16, Article 30 of the West Virginia Code, also called the West Virginia Health Care Decisions Act, is the document that regulates the medical power of attorney in West Virginia.

Section 16-30-4 provides that the principal must sign the medical power of attorney before two adult witnesses and a notary public.

How to Write a Medical Power of Attorney in West Virginia

To make a valid and effective medical power of attorney, your document must be in line with West Virginia state laws and regulations.

The following section offers a detailed guide that will walk you through the process of drafting a medical power of attorney that is both valid and effective. 

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

On our website, you will find the medical power of attorney template. Our document builder will lead you through the whole process of drafting the document by asking you simple questions and populating the document according to your answers

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

#2. Appoint a Healthcare Representative

The healthcare representative is also called the agent or attorney-in-fact. In this section, you will enter the full name, mailing address, and contact details of the person you want to authorize as your healthcare representative.

The healthcare representative should be an adult with the legal capacity to act. Moreover, it should be someone you trust. You can appoint your spouse, a relative, a friend, or another trusted advisor as your healthcare representative. 

Include the rights and limitations associated with the medical power of attorney, as well as a description of the scope of authority that your agent possesses.

#3. Identify an Alternative Healthcare Representative

An alternative healthcare representative is also referred to as an alternative agent, secondary agent, or secondary attorney-in-fact. Their role is to act only in situations where the primary agent is unable to act due to their physical or mental state, legal capacity, or location.

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

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

After you have finalized the medical power of attorney form, you should sign it in front of at least two witnesses. 

The witness cannot be:

  • A person related to the principal by marriage or blood

  • A person entitled to any portion of the estate of the principal

  • Someone who is directly financially responsible for the principal’s medical care

  • The principal’s attending physician or agent

#5. Notarize the Form

Finally, you should have your witness’s signature as well as yours acknowledged by the notary public. The notary public will confirm your and your witness’s identities and confirm that you personally signed the document. 

This will additionally confirm the authenticity of the document and prevent potential fraud.

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