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Healthcare Power of Attorney

Document appointing a healthcare agent to make medical decisions on your behalf when you are unable to communicate your own wishes.

PDF TemplateUse the instructions below to complete this form

Instructions

Name a primary healthcare agent and at least one alternate. Specify the scope of authority: consent to or refuse treatment, access medical records, choose healthcare providers, and make end-of-life decisions. Many states have statutory forms — use your state's approved version. Sign with two witnesses who are not your agent. This becomes effective only when your doctor certifies you are unable to make your own decisions.