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 if their circumstances change. For instance, if the relationship with the designated agent deteriorates or if the individual wishes to appoint someone else, this form serves to formally communicate that change.
• Situations requiring a change in health care preferences often arise when a person undergoes significant life changes, such as marriage or divorce. In such cases, revoking an existing Health Care Power of Attorney ensures that the individual's current wishes are accurately represented and respected in medical situations.
• To comply with new legal requirements or personal beliefs, a person may decide to revoke their previous Health Care Power of Attorney. This form provides the necessary documentation to ensure that health care providers are aware of the updated directives and can act accordingly.
• For those who have experienced a change in health status or have developed new medical conditions, it may be essential to revoke a previously established Health Care Power of Attorney. This ensures that the individual’s current health care preferences align with their medical needs and personal values.
• In cases where the appointed agent is no longer capable of fulfilling their role due to health issues or other reasons, revoking the Health Care Power of Attorney allows the Grantor to appoint a more suitable representative. This form is crucial for maintaining effective and appropriate decision-making in health care matters.