Filling out a medical power of attorney (MPOA) form is serious business, and you need to be certain to fill in the details correctly. However, there’s a chance you will encounter some unfamiliar terms that can confuse you. 

To clarify things and make the process easier, we’ll take a look at some classic medical power of attorney examples.

Medical POA Examples 

A medical power of attorney is a vital legal document that allows you to designate someone to make healthcare decisions on your behalf if you cannot. This person, known as the agent, steps in when you are incapacitated due to illness or injury.

Having a medical POA makes certain your healthcare preferences are respected. Without it, decision-making may default to family members, possibly leading to conflicts or decisions that don't align with your wishes. It's a proactive step to maintain control over your medical treatment in unforeseen circumstances.

Example 1: Choosing Your Power of Attorney

Select someone you trust implicitly, like a close family member or friend. This person will make healthcare decisions on your behalf if you become incapacitated. Think about their availability, reliability, and understanding of your healthcare wishes.

The statement typically reads: "I hereby appoint [Name of Healthcare Agent] as my healthcare agent to make decisions regarding my healthcare."

Example 2: Granting Authority to Your Power of Attorney

Decide what decisions you want your POA to make. This could include authorizing medical treatments, consenting to surgeries, or making decisions about life-sustaining care. Provide clear instructions about your wishes regarding resuscitation, organ donation, and end-of-life care.

The statement typically reads: "My healthcare agent is authorized to make decisions about [list of decisions, such as medical treatments, surgeries, resuscitation, organ donation, etc.]."

Example 3: Authorizing Your Physician

Give your POA permission to communicate with your doctors and healthcare providers. Allow your POA to access your medical records.

Lauren Klein, attorney and co-founder of Flourish Law Group in Fort Lauderdale, Florida, explains:

“In Florida, a Designation of Health Care Surrogate is a document naming another person as your representative to make medical decisions for you if you are unable to make them yourself. You can include instructions about any treatment you want or do not want, similar to a living will. You can also designate an alternate surrogate.”

The statement typically reads: "My healthcare agent is authorized to communicate with my physicians and healthcare providers and to access my medical records."

Example 4: Deciding on Medical Procedures

Specify whether your POA can consent to medical procedures, surgeries, or experimental treatments. Set any limitations or conditions you want to place on their decision-making authority.

The statement typically reads: "My healthcare agent is authorized to consent to medical procedures, surgeries, or experimental treatments on my behalf."

Example 5: Granting Full Authority

Decide if you want to give your POA complete control over your healthcare decisions or if you prefer to maintain some level of involvement. Make your MPOA revocable, meaning you can change your mind and appoint a different POA or revoke the document altogether.

The statement typically reads: “I grant my healthcare agent full authority to make all healthcare decisions on my behalf."

Example 6: Addressing All Legal Provisions

Make sure your MPOA complies with state laws and regulations. Consult with a lawyer to make sure your MPOA is legally sound and protects your best interests.

The statement typically reads: "This MPOA is subject to the laws of the State of [State]."

Example 7: Administrative Details

Specify when the MPOA takes effect. It can be upon your incapacity or immediately upon signing. Have the MPOA signed by you, witnessed by two individuals, and notarized.

The statement typically reads: "This MPOA shall become effective [immediately upon signing] or [upon my incapacity]."

Example 8: Executing the Document

Sign the MPOA in the presence of witnesses. Take the signed document to a notary public for official certification.

The statement typically reads: "I, [Your Name], sign this MPOA on [Date]."

Example 9: Witnesses and Notarization

Ensure the witnesses are not related to you or the POA and are not beneficiaries under your will or estate plan. A notary public verifies the authenticity of your signature and the witnesses' signatures.

The statement typically reads:

• Witness Signatures: "[Witness 1 Signature] [Witness 2 Signature]"

  
  

• Notary Public: "[Notary Public Stamp]"

Example 10: Mental Competence

Confirm that you are of sound mind and understand the implications of signing the MPOA. If there are any concerns about your mental capacity, a medical professional may need to evaluate you.

The statement typically reads: "I declare that I am of sound mind and understand the nature and consequences of this document."

Remember that these are just examples, and your specific MPOA may include additional clauses or provisions based on your individual needs and preferences. Always consult with an attorney to verify your MPOA is legally valid and addresses your unique circumstances.

Storing Your MPOA

Your MPOA is a vital document, so it must be stored somewhere safe but accessible. You can store a digital copy on a platform like Trustworthy alongside your other important documents. Trustworthy allows you to store your private documents safely and share them with trusted individuals.

With Trustworthy, you can also store other important information, such as financial records and passwords. It’s a one-stop shop where your family can access any documents they need in the event of your incapacitation. 

Frequently Asked Questions

When should you consider setting up a medical POA?

You should consider setting up a medical POA if you are concerned about future medical situations where you might be unable to make your own decisions. Significant life events, chronic illnesses, or upcoming surgeries are good times to establish one. Planning gives you peace of mind, knowing your healthcare wishes will be honored.

Who can be your agent for a medical POA?

Your agent for a medical POA can be anyone you trust, such as a family member, friend, or partner. It’s vital to choose someone reliable who understands your medical preferences. Discuss your decisions with them to make sure they are comfortable making these choices on your behalf.

What are the limitations of a medical POA?

A medical POA can be limited by state laws, personal preferences, or specific instructions you include in the document. For example, certain procedures might be excluded from the agent’s authority. Clear communication and detailed documentation can help set these boundaries effectively.