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 relationship with the appointed agent or a change in health status. This form provides the legal means to formally notify all relevant parties of the revocation.
• Situations requiring the revocation of a Health Care Power of Attorney can arise when the Grantor wishes to appoint a new agent due to dissatisfaction with the previous choice. By using this form, the Grantor ensures that the new agent has the authority to make health care decisions moving forward.
• For those who have experienced a significant life event, such as divorce or the death of a previously appointed agent, it may be crucial to revoke an existing Health Care Power of Attorney. This form serves as a clear and formal declaration that the previous document is no longer valid.
• Healthcare providers may need to verify that a Health Care Power of Attorney has been revoked to ensure they are acting in accordance with the Grantor's current wishes. The use of this form helps eliminate any confusion regarding the authority of the previous agent.
• In cases where the Grantor has decided to take control of their own health care decisions without a designated agent, this form allows them to revoke any prior authorizations. This ensures that their medical preferences are respected and that no one else has the authority to make decisions on their behalf.