Allows you, the grantor, to designate a trusted individual, the agent, to make necessary health care decisions on your behalf and sets forth the specific powers, including the powers to refuse or consent to certain forms of medical treatment.

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A Power of Attorney for Health Care allows you (referred to as the Grantor or Principal) to appoint another person (referred to as Agent) to make health care decisions on your behalf. These decisions can include requiring, withdrawing, refusing or consenting to any form of medical treatment or personal care for any mental or physical condition. It also allows the agent to admit you or discharge you from any hospital or other institution.

This is not the same thing as a Living Will or an Advance Directive, although a Power of Attorney for Health Care is often part of an Advance Health Care Directive.

Some of the important provisions included in this Power of Attorney for Health Care are:
  • Grantor and Agent: Names of the Grantor and the Agent that is appointed;
  • Alternate Agent: Names of an alternate Agent;
  • Grant of Power: The various powers to make health care decisions granted to the Agent;
  • Signature of Grantor: Confirms that these are the wishes of the person whose name appears on the document.
  • Witnesses: Declares that the person whose name is on the document is of sound mind.

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This form prepared by lawyers includes:
  1. Information and Instructions for the Power of Attorney for Health Care
  2. Power of Attorney for Health Care
State Law Compliant This form was prepared for use in your state.
Number of Pages4
DimensionsDesigned for Letter Size (8.5" x 11")
EditableYes (.doc, .wpd and .rtf)
UsageUnlimited number of prints
Product number#16947

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