Free Medical Power of Attorney Form

The Medical Power of Attorney is recognized by all 50 states. Many states use different names such as Health Care Power of Attorney, Health Care Proxy, Health Care Agent, and Health Care Representative. It is your responsibility to check with your state to determine if the medical care power of attorney is legally adequate for your needs.

Free Medical Power of Attorney Form
Free Medical Power of Attorney Form

The Medical Power of Attorney is very easy to complete. Most of the time involved will be deciding ahead of time which choices you want implemented if or when the time comes. Do you want to remain on life support even if there is no brain activity? Do you want medical personnel attempting to revive you if you go into cardiac arrest? Do you want to donate your organs and tissues after you’ve passed away? The best time to make these decisions is when you’re healthy and in a clear frame of mind.

It is imperative that you explain your choices to the person you are appointing as your medical representative. The person needs to know what your choices are for as many conceivable circumstances as possible. How long do you want to continue with life support before making the decision to pull the plug? Do you have any fears of certain medical treatments or procedures? Do you want to breath on your own at all times or is a breathing machine acceptable?


Click the link below to download the Medical Power of Attorney Form in Microsoft Word format . You may also create the Medical Power of Attorney Form using our free fillable PDF version. The PDF has fillable fields into which you can type the required information.

WORD – Medical Power of Attorney Form

PDF – Medical Power of Attorney Form

Medical Power of Attorney Forms By State

CaliforniaMichiganRhode Island
ColoradoMinnesotaSouth Carolina
ConnecticutMississippiSouth Dakota
IdahoNew HampshireVirginia
IllinoisNew JerseyWashington
IndianaNew MexicoWashington DC
IowaNew YorkWest Virginia
KansasNorth CarolinaWisconsin
KentuckyNorth DakotaWyoming

This medical power of attorney form alongside most of the other legal forms provided on this site are provided “as is” without limited or express warranties. This includes, yet is not constricted to, warranty of merchantability or fitness for any type of type of particular use.

This medical power of attorney form was not constructed by an attorney or law practice. It is your responsibility to figure out if the record is legitimately proper for your criteria.

You have to similarly ensure that the form is submitted completed and additionally notarized and/or witnessed if needed.

As a web page visitor of this site, you assume all liabilities along with accountability for employing this medical power of attorney form as well as completing.

We do not assume any type of legal liability or commitment for the correctness or functionality of the legal document.


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