Use This Form If:

• Individuals who have previously designated a Health Care Power of Attorney may find it necessary to revoke that authority if their circumstances change, such as a change in relationships or personal beliefs regarding medical treatment. This form provides a clear and formal way to communicate that decision to relevant parties.
• Situations requiring the revocation of a Health Care Power of Attorney may arise when the designated agent is no longer able or willing to act on behalf of the Grantor. In such cases, using this form ensures that the previous agent is officially notified and that the Grantor's current wishes are respected.
• For those who have created a Health Care Power of Attorney but have since decided to take a different approach to their medical care, this revocation form serves as a necessary legal document to prevent any misunderstandings. It allows the Grantor to assert their autonomy over future health care decisions.
• When an individual wishes to appoint a new agent for their Health Care Power of Attorney, it is essential to revoke the previous document to avoid confusion. This form provides a straightforward method to ensure that the old authority is nullified before the new one is established.
• In cases where a Grantor has experienced a significant life event, such as a divorce or the death of a spouse, they may wish to revoke their existing Health Care Power of Attorney. This form facilitates the formal termination of the previous arrangement, allowing for a fresh start in terms of health care decision-making.