Use This Form If:

• Individuals who have previously designated someone to make health care decisions on their behalf may find it necessary to revoke that authority due to a change in personal circumstances, such as a new relationship or a loss of trust in the appointed agent. This form provides a clear and formal way to communicate the revocation to all relevant parties.
• Situations requiring the revocation of a Health Care Power of Attorney may arise when the Grantor's health status changes significantly, prompting them to reconsider their previous choices. By using this form, they can ensure that their current wishes are legally recognized and respected by healthcare providers.
• For those who have created a Health Care Power of Attorney but have decided to take a different approach to their medical decision-making, such as opting for a different agent or a different type of directive, this revocation form serves as a necessary step to clarify their intentions.
• In cases where the original agent designated in the Health Care Power of Attorney is no longer able or willing to fulfill their role, the Grantor may choose to revoke the previous document. This form allows them to formally notify all parties involved, ensuring that their health care preferences are accurately represented.
• When a person wishes to simplify their estate planning documents or consolidate their health care directives, they might decide to revoke an existing Health Care Power of Attorney. This form is essential for ensuring that all stakeholders are aware of the change and that the previous document is rendered void.