Purpose:
Names the person you wish to grant power to make any and all healthcare decisions on your behalf.
Notes:
- The named agent’s authority begins when your doctor certifies that you lack the competence to make health care decisions.
- Allows for alternates to be named, which is wise in case the first cannot be reached in an emergency.
- Do not lock this document up as it must be available in a crisis. Copies are valid and the named agent and alternates should all have one.
- Allows one to list limitations on the agent’s decision making authority.
- States where the original document is to be kept and what individuals or institutions have signed copies.
- Requires 2 witnesses and notarization.
- Although optional, it is important to include the “HIPAA Release Authority” for your named agent to have access to health information and medical records.
- This document may not be changed or modified. If you want to make changes in the document, you must make an entirely new one.
Download the template:
Medical Power of Attorney with HIPAA Release