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Healthcare Power of Attorney

Federal & State Law Editorial TeamLast reviewed: April 2026

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.

This is legal information, not legal advice. Laws vary by jurisdiction and change frequently. Always verify current law with official sources and consult a licensed attorney in your jurisdiction for advice on your specific situation.