A Medical Power of Attorney (MPOA) form empowers you, as the principal, to designate an agent who will make critical healthcare decisions on your behalf should you become incapacitated and unable to communicate your preferences. This legal document becomes fully effective only after a licensed physician certifies your incapacity.

Statutory Forms – by State

You can find the official name below, as the name of the form differs by state.

Signing Requirements

States have different requirements for MPOA forms to be witnessed, but they need to be authorized in the presence of witnesses, a notary public, or both. This is the requirement that your signature be witnessed.

How to Obtain a Medical Power of Attorney

Creating a legally sound MPOA involves a few essential steps:

Step 1 – Choose Your Agent:

Select an agent who is at least 18 years old, mentally competent, and not affiliated with your healthcare facility. This person, whether a friend, family member, spouse, or professional, should be someone you trust to advocate for your well-being, understand your medical preferences, and be emotionally capable of making challenging decisions on your behalf.

Step 2 – Define Your Agent’s Authority:

Clearly outline the scope of your agent’s authority in the MPOA. Without specific limitations, your agent will have the power to make decisions regarding your medical care, treatments, medications, surgeries, and more. This includes crucial choices related to life support, tube feeding, CPR, admission or discharge from healthcare facilities, medical research, palliative care, and organ or tissue donation.

Step 3 – Include Living Will or DNR:

Attach other Advance Directives, such as a Living Will or a Do-Not-Resuscitate form, to your MPOA. This ensures that your agent and healthcare professionals have easy access to detailed healthcare wishes. While an MPOA designates an agent to make decisions, a Living Will outlines your preferences for specific life-sustaining and end-of-life medical treatments.

Step 4 – Sign and Distribute Copies:

Ensure your MPOA complies with your state’s signing requirements for legal validity. Once properly signed, distribute copies to your primary agent, alternate agent, primary physician, loved ones, healthcare institutions, and residential/palliative care facilities where you receive care. Carry a copy with you, even for outpatient procedures, and file the original in your records.

MPOA vs. Living Will

It's essential to distinguish between Medical Powers of Attorney and Living Wills:

Medical Power of Attorney (MPOA):

• Appoints an agent to make healthcare decisions when you are incapacitated.
• Covers a broad range of medical decisions and treatments.
• Effective in situations of temporary incapacitation with expected recovery.

Living Will:

• Outlines specific preferences for life-sustaining and end-of-life medical treatments.
• Doesn’t appoint an agent to make decisions.
• Effective when diagnosed as terminally ill, permanently unconscious, or in a similar end-stage condition.

Understanding the distinctions allows individuals to create a comprehensive estate plan that aligns with their healthcare preferences.

By following these steps, you ensure that your Medical Power of Attorney is legally binding and that your healthcare decisions are in the hands of a trusted advocate should the need arise. Always stay informed about your state’s requirements to guarantee the validity of your MPOA.

Medical Power of Attorney Sample