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Medical Power of Attorney (MPOA) Form

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Updated February 25, 2026

A medical power of attorney form lets a person (principal) appoint someone else (agent) to make healthcare decisions on their behalf. The agent’s powers are effective after the principal becomes incapacitated or lacks the capacity to make medical decisions.

Key Features

  • Ensures wishes are followed. Allows a trusted person (agent) to make healthcare decisions that align with your values.
  • Protection from incapacitation. Lets an agent step in and make healthcare decisions if the principal cannot for themselves.
  • Prevents family conflict. Selects one person to be solely responsible for making all medical decisions.
  • Effective immediately. The agent can begin making decisions for the principal after signing it.
  • Supplements other directives. Use with a living will or advance directive to complete an end-of-life plan.

By State

How to Get a Medical POA (4 steps)

1. Select an Agent

If a principal has the capacity to make decisions for themselves, they are legally able to appoint a health care agent.[1]

The agent selected will be responsible for making decisions based on the principal’s healthcare. Therefore, it’s recommended to select a trusted individual who is aware of the principal’s medical history (e.g., heart conditions, medication, allergies, etc.)

2. Agent’s Decisions

The principal can limit the agent to make the following decisions:

  • Autopsy options
  • Burial preferences
  • Surgical treatments
  • Nursing home treatment/care
  • Hospitalization
  • Medical treatment
  • Psychiatric treatment
  • Homestay care
  • Organ donation
  • End-of-life decisions

3. Attach a Living Will

A living will is a legal document that outlines a person’s end-of-life treatment options. Specifically, if a patient becomes in a medical condition with no cure, it elects the decision to be made whether to not prolong their life.

A living will  is recommended to be attached to any medical power of attorney created.

4. Sign and Complete

A medical power of attorney must be signed in accordance with state signing laws. This commonly includes witnesses and/or a notary public (see state laws).

When can an agent make medical decisions?

When the patient is considered to lack the capacity to make a health care decision (incapacitated).[2]

When is a patient determined to be incapacitated?

A patient can be determined to be incapacitated by:

  • A physician
  • A psychologist licensed in the state;
  • An individual with training or expertise in the finding of lack of capacity who is licensed in the state as;
    • A physician’s assistant;
    • An advanced practice registered nurse; or
    • A social worker.
  • A responsible healthcare worker who is not described hereunder.[3]

Medical POA vs Living Will

Medical POA – Lets a person select their preferred treatment options with the use of an agent to carry out their wishes. Based on the principal’s wishes, the agent has the authority to prolong or withdraw life-sustaining treatment.
Living Will – Lets a person select their preferred treatment options without the use of an agent. The medical staff must follow the end-of-life treatment requests as written.

Statutory Forms: By State

STATE STATUTORY FORM LAWS
 Alabama Advance Directive for Health Care § 22-8A-4(c)(4)
 Alaska Advance Health Care Directive AS 13.52.010
 Arizona Health Care Power of Attorney § 36-3224
 Arkansas Durable Power of Attorney for Health Care

§ 20-6-103
 California Advance Health Care Directive PROB § 4701
 Colorado Medical Durable Power of Attorney

§ 15-14-506
 Connecticut Appointment of Health Care Representative Sec. 19a-575a
 Delaware Advance Health Care Directive § 2505
 Florida Designation of Health Care Surrogate § 765.202(1)
 Georgia Advance Directive for Health Care § 31-32-4
 Hawaii Advance Health Care Directive Form § 327E-16
 Idaho Advance Care Planning Document § 39-4510
 Illinois Durable Power of Attorney for Health Care 755 ILCS 35/3(b)
 Indiana Health Care Representative Appointment IC § 16-36-7-28
 Iowa Durable Power of Attorney for Health Care Decisions § 144B.5
 Kansas Durable Power of Attorney for Healthcare Decisions § 58-632
 Kentucky Advance Directive § 311.629
 Louisiana Medical Power of Attorney RS 28:223
 Maine Health Care Advance Directive Form

§ 5-805
 Maryland Advance Directive § 5-603
 Massachusetts Health Care Proxy § 201D-2
 Michigan Durable Power of Attorney for Health Care § 700.5501(b)
 Minnesota Health Care Directive

§ 145C.16
 Mississippi Advance Health Care Directive § 41-41-209
 Missouri Durable Power of Attorney for Health Care § 404.822
 Montana Durable Power of Attorney for Health Care § 53-21-1304
 Nebraska Power of Attorney for Health Care § 30-3404
 Nevada Durable Power of Attorney for Healthcare Decisions NRS 162A.860
 New Hampshire Advance Directive Section 137-J:20
 New Jersey Medical Power of Attorney (proxy) § 26:2H-57
 New Mexico Advance Directive for New Mexico § 24-7A-4
 New York Health Care Proxy PBH § 2981
 North Carolina Health Care Power of Attorney § 90-321
 North Dakota Health Care Directive § 23-06.5-17
 Ohio Health Care Power of Attorney Section 1337.17
 Oklahoma Advance Directive for Health Care § 63-3101.4
 Oregon Advance Directive for Health Care ORS 127.527
 Pennsylvania Durable Health Care Power of Attorney § 5471
 Rhode Island Durable Power of Attorney for Healthcare § 23-4.10-2
 South Carolina Health Care Power of Attorney § 62-5-504
 South Dakota Durable Power of Attorney for Health Care § 59-7-2.1
 Tennessee Advance Directive for Health Care § 68-11-1803(b)
 Texas Durable Power of Attorney for Health Care § 166.161
 Utah Advance Health Care Directive § 75-2a-117
 Vermont Advance Directive for Health Care 18 V.S.A. § 9703
 Virginia Advance Medical Directive § 54.1-2984
 Washington Durable Power of Attorney for Health Care § 11.125.100
 Washington D.C. Power of Attorney for Health Care § 21–2207
West Virginia Medical Power of Attorney § 16-30-4
 Wisconsin Power of Attorney for Health Care § 155.30
 Wyoming Advance Health Care Directive § 35-22-403

Signing Requirements: By State

Some states have limitations on who can be a witness for the principal. For example, in California, a witness cannot be:

  • Related by blood, marriage, or adoption;
  • Beneficiaries to the principal’s estate;
  • The agent; or
  • Any health care worker or medical staff providing care to the principal.
STATE SIGNING REQUIREMENTS LAWS
 Alabama Two (2) Witnesses § 22-8A-4(c)(4)
 Alaska Notary Public or Two (2) Witnesses AS 13.52.010(b)
 Arizona Notary Public or One (1) Witness § 36-3221(A)(3)
 Arkansas Notary Public or Two (2) Witnesses § 20-6-103(c)
 California Notary Public or Two (2) Witnesses § 4701(e)
 Colorado No law (Notary Public recommended)

§ 15-14-506
 Connecticut Two (2) Witnesses § 19a-575
 Delaware Two (2) Witnesses § 2503(b)(1)(d)
 Florida Two (2) Witnesses § 765.202(1)
 Georgia Two (2) Witnesses § 31-32-5
 Hawaii Notary Public and Two (2) Witnesses § 327E-3(1)
 Idaho No law (Notary Public recommended) § 39-4510
 Illinois One (1) Witness 755 ILCS 45/4-5.1
 Indiana Notary Public or Two (2) Witnesses IC § 16-36-7-28
 Iowa Notary Public or Two (2) Witnesses § 144B.3(b)
 Kansas Notary Public and Two (2) Witnesses § 58-632
 Kentucky Notary Public or Two (2) Witnesses § 311.625(2)
 Louisiana Two (2) Witnesses § 224 (A)
 Maine Two (2) Witnesses § 5-803(2)
 Maryland Two (2) Witnesses § 5–603
 Massachusetts Two (2) Witnesses § 201D-2
 Michigan Two (2) Witnesses § 700.5506(4)
 Minnesota Notary Public or Two (2) Witnesses § 145C.03(5)
 Mississippi Notary Public or Two (2) Witnesses § 41-41-205(2)
 Missouri Notary Public § 404.705(3)
 Montana Two (2) Witnesses § 50-9-103
 Nebraska Notary Public or Two (2) Witnesses § 30-3404(5)
 Nevada Notary Public or Two (2) Witnesses NRS 162A.790
 New Hampshire Notary Public or Two (2) Witnesses § 137-J:14
 New Jersey Notary Public or Two (2) Witnesses § 26:2H-56
 New Mexico Two (2) Witnesses § 24-7A-4
 New York Two (2) Witnesses PBH § 2981(2)
 North Carolina Notary Public and Two (2) Witnesses § 32A-16A(3)
 North Dakota Notary Public or Two (2) Witnesses § 23-06.5-05(d)
 Ohio Notary Public or Two (2) Witnesses § 1337.12(1)(b)
 Oklahoma Two (2) Witnesses 63 O.S. § 3101.4(A)
 Oregon Notary Public or Two (2) Witnesses § 127.515(2)
 Pennsylvania Two (2) Witnesses § 5452(b)(2)
 Rhode Island Notary Public or Two (2) Witnesses § 23-4.10-2(9)
 South Carolina Notary Public and Two (2) Witnesses § 62-5-517
 South Dakota Notary Public or Two (2) Witnesses § 34-12D-2
 Tennessee Notary Public or Two (2) Witnesses § 34-6-203(a)(3)
 Texas Notary Public or Two (2) Witnesses § 166.154
 Utah One (1) Witness § 75-2a-107(c)
 Vermont Two (2) Witnesses § 9703(b)
 Virginia Two (2) Witnesses § 54.1-2983
 Washington Notary Public or Two (2) Witnesses § 70.122.030
West Virginia Notary Public and Two (2) Witnesses § 16-30-4(a)
 Wisconsin Two (2) Witnesses § 155.10(1)(c)
 Wyoming Notary Public or Two (2) Witnesses

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