1. Fill out the power of attorney for health care form
Fill out the form listed below:
- Power of Attorney for Health Care: This program will help you fill out a power of attorney for health care.
Note: Do not sign the power of attorney for health care until Step 3. You do not need to make copies of this form until Step 4.
2. Print out the power of attorney for health care
After you have filled out the form, print out the document, then:
- Read your document carefully to be sure that you understand it and agree with what is written.
- Write your initials next to the X’s which mark the choices you made on each page.
3. Sign the power of attorney for health care in front of a notary and a witness
Next, you will need to find at least one witness. If possible, you should find two witnesses. The witness must be at least 18 years old and be mentally competent.
The witness must not be:
- Your doctor or health care provider
- A person you listed as an agent in the document
- A person who helped you write the document
- A close relative of you or your agent
The person you give the power of attorney to is the agent and you are the principal. The agent is usually a spouse, a close friend, or a trusted relative.
You and the witness should sign the document in front of a notary, and show the notary your IDs. Then, the notary should notarize the document.
4. Give copies to the right people
Once it is notarized, make multiple copies. Give one copy to your primary medical doctor. Also give copies to other health care providers who you see regularly. If you live in a nursing home or assisted living facility, give a copy to the administrator.
If you don't think your agent will need to use the power of attorney any time soon, keep the original and give your agent a copy. Be sure to tell your agent where to find the original. Give your agent the original if you are already sick, or think your agent might need to use it soon.
5. Use your power of attorney for health care
Your health care provider will call your agent if you become too sick or injured to make your own decisions. Your agent must bring the original document to the health care provider treating you. The health care provider won't listen to your agent without the original document.
Updated: January 2017