Medical Power of Attorney (MPOA) Form Template

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A medical power of attorney (MPOA) is a legally binding document where a person, typically known as the principal, designates another individual, often termed the agent or attorney-in-fact, to make healthcare decisions. Craft your medical POA document on Loio and get a complete legally binding document in PDF in minutes.
Medical Power of Attorney

I,   residing at   (the "Principal"), appoint   residing at   as my agent (the "Agent") to make healthcare decisions on my behalf, in my stead, and for benefit, in any lawful way, if I am unable to make or communicate these decisions myself, including decisions regarding medical treatment, surgery, medication, and other healthcare-related matters.

If the Agent named in this Medical Power of Attorney is unable or unwilling to make decisions for me, I designate the following individual as an alternate Agent:

  residing at  .

My Agent is authorized to:

Medical preferences 

Life-sustaining treatment: In the event of a medical condition where my attending physician determines that my condition is terminal or that I am in a permanent unconscious state with no reasonable hope of recovery, I express the following preferences regarding life-sustaining treatment:

  • I request all life-sustaining treatments be administered, even if my condition is considered terminal.
  • Organ donation: I hereby authorize the donation of any of my organs or tissues for transplantation or medical research, if medically suitable.
  • Palliative care: I request palliative care, including the relief of pain and suffering, to be provided to me to the greatest extent possible.
  • End-of-life location: If medically possible, I prefer to receive end-of-life care at home.

Effective date. This Medical Power of Attorney shall become effective immediately upon my incapacitation.

Duration. This Medical Power of Attorney shall remain in effect unless revoked by me in writing or upon my death.

Revocation. I have the right to revoke this Medical Power of Attorney at any time by providing written notification to my Agent and healthcare providers or by any other means in accordance with applicable laws.

I declare that I am of sound mind, and I am signing this document voluntarily. I understand its purpose and significance.

IN WITNESS THEREOF, this Power of Attorney is executed on  .

Principal

Signature: _____________

Full name:  

Address:  


Witness 1

Signature: _____________

Full name:  

Address:  


Witness 2

Signature: _____________

Full name:  

Address:  

Notary Acknowledgment

Sworn to and subscribed before me on  .

____________________

Notary public's name and seal

Written by Karyna Pukaniuk - Reviewed by Jonathan McGill

Template Description

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Paper titled "Medical Power of Attorney"; patient and his friend are talking to a nurse

Medical power of attorney forms (POAs) assign people with one’s healthcare decisions when they’re incapable due to physical or mental issues. The person entrusted to fulfill healthcare obligations must be reliable, responsible, and mentally competent. These qualities are mandatory to support the author of a healthcare power of attorney form in the long term, so this POA form must be carefully written and revised before signing.

This guide to power of attorney for healthcare forms will cover common cases of using this legal document, explain its key sections, and share how to create a medical power of attorney template. 

What Is a Medical Power of Attorney?

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A health care power of attorney form is a legally binding document between the principal and the agent, regulating critical medical care options, treatment preferences at a health care facility, relationships with health care providers, advance care planning, financial decisions, etc.

The principal creates the medical power of attorney document and assigns the agent to represent their interests and act on their behalf when the principal is incapable. The agent or attorney-in-fact should be a trusted person. They must be ready to fulfill the principal’s own wishes and preferences with due diligence and respect. 

Once a free medical power of attorney form PDF is ready, two witnesses must be present while the main parties are signing the legal document. The witnesses should also sign the medical POA form to confirm that the principal is incapacitated in making their own wishes and health care decisions, and the document enters its legal force and is ready for notarization.

Medical POA vs Living Will

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Medical power of attorney forms require the agent to make treatment decisions on behalf of the patient once they become incapable.

Living wills, on the other hand, allow medical staff to decide on the patient’s medical treatment options. If the patient’s condition significantly worsens, doctors have the right to refuse life-sustaining treatment based on the signed living will.

When to Use a Medical Power of Attorney

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The main scenarios for employing free medical power of attorney forms to print are the following:

  • You are critically ill and/or currently undergoing medical treatment or therapy, so you are unable to make health care decisions yourself;

  • You need to leave an entrusted person instructions regarding end-of-life care;

  • You are obliged to act on behalf of the patient in various medical decisions and represent their best interests.

A written medical POA form is a must for resolving medical issues for someone. The oral agreement between the parties is invalid and will result in legal complications when new healthcare issues arise.

You can find and download free printable medical power of attorney forms on various online legal template libraries, should you need this official document template immediately. Having a free medical power of attorney form at hand will help you grant the right person the healthcare decision-making power on time and bring you peace of mind.

Key Terms of a Medical POA

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Here’s the list of common legal terms you may find in medical power of attorney forms:

  • Power of attorney (POA): The legal right allowing someone to make decisions on another person’s behalf.
  • Scope of authority: This section describes the principal’s medical preferences and wishes regarding their health to authorize the agent, e.g., surgery, organ donation, homestay care, life sustaining treatments, end-of-life care, etc.
  • Duration: This is the period when power of attorney will remain legally enforceable.
  • Incapacitation: The health state when one cannot act or make their own decisions.
  • Revocation: The clause of the medical POA termination by the principal.

The Loio medical power of attorney document already includes the aforementioned key terms and is premade for customization to your legal requirements. Start answering comprehensive questions related to the content of your document and add all necessary information in minutes.

How to Write a Medical Power of Attorney

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Here are the detailed steps on how to draft a free medical POA form on your own without errors:

  1. Write down the names of the principal and agent and their contact information;

  2. Define the scope of the agent’s powers when the principal is incapable of making their own medical decisions;

  3. Choose the duration of your medical power of attorney document, which equals the duration of medical care;

  4. Add the effective date of this power of attorney;

  5. Check the prepared power of attorney template and share it with the counterparty for doublecheck;

  6. Sign the medical POA form before family members, witnesses and/or the notary public.

In the end, you will get a free printable medical power of attorney form that you can reuse later and always edit to your situation.

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