Health Care Power of Attorney form

A power of attorney allows you to authorize someone you trust to speak for your medical wishes. If you’re under anesthesia, if you’re on medication, and can’t consent to a procedure, who do the medical team talk to, call whoever you appointed. You have a care power of attorney.

The durable healthcare power of attorney helps the medical team better to understand patient wishes in a time when they may not be able to communicate for themselves.

People sometimes wonder who they should name is their agent, you can name any adult to be your medical power of attorney

There are four pieces that are required to make it a legal document

    • The first is your name and birthdate.
    • The second is the name and telephone number of anybody you want to speak for your medical wishes. Then you can name two alternates we would go to the alternates only if the original agent is not available. Alternates are good to have but not required. The authority of the agent is listed on page four. You’re giving that person permission to consent to procedures to have treatments done and to request medical information 
    • The third piece is your signature 
    • The fourth piece is either a notary or two witnesses and their signatures there’s a section in the document .
    • On page five for people to write in free text so people can add-in what they want.
    • Everyone have different beliefs, different values and, you want to make sure that those beliefs and values are honored having a health care power of attorney is a way to assert

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