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 appointed agent deteriorates or if the individual wishes to appoint someone else, this form is essential to formally notify all parties involved.
• Situations requiring a change in health care decision-making authority often arise when a person experiences a significant life event, such as divorce or the death of a previously designated agent. In such cases, the Health Care Power of Attorney Revocation serves as a critical tool to ensure that the individual's current wishes are respected and legally recognized.
• To comply with legal standards, a person may need to revoke a Health Care Power of Attorney if they regain capacity to make their own medical decisions. This form provides the necessary documentation to inform health care providers and family members that the previous directive is no longer valid.
• For those who have reconsidered their health care preferences, revoking a previously established Power of Attorney is crucial. This may occur if the individual has developed new health care preferences or wishes to align their medical decisions with their current values and beliefs.
• In cases where a health care agent has acted contrary to the wishes of the Grantor, it becomes imperative to revoke the existing Power of Attorney. This form allows the Grantor to clearly communicate their decision to revoke authority and prevent further actions by the agent.