Need someone you trust to speak with doctors if you cannot? Create a medical power of attorney form free to start: answer guided questions, preview the document, then download as PDF or Word when you are ready.
You name one person you trust (your health care agent) to make treatment decisions when you cannot make them yourself, and to see the medical records they need to do it. In Michigan, this person is called a patient advocate.
You can use this form in any state. Before you sign, check whether your state asks for two witnesses, a notary, or both. If your state publishes its own official healthcare proxy form, compare the two and use whichever your doctors and hospitals will accept.
What is a medical power of attorney?
A medical power of attorney (medical POA) is a legal document that lets you (the principal) appoint another person (your health care agent) to make health care decisions if a physician determines you cannot make them yourself. Your agent should follow your known wishes and, when those are unclear, act in your best interest.
A medical POA is about who decides. It is different from a living will, which focuses on written treatment preferences (for example, life-sustaining treatment in end-of-life situations). Many people complete both. This form also typically authorizes access to medical information so your agent can talk with providers (often discussed alongside a HIPAA release).
The U.S. Administration for Community Living explains advance care planning and appointing a decision-maker in its Advance Care Planning resources. State health departments publish local forms and execution rules; always confirm your state’s requirements before you rely on the document.
A medical power of attorney works when you name a willing health care agent, grant clear decision-making and records access, discuss your wishes in advance, and sign with the witnesses or notary your state expects.
Medical POA vs living will
| Question | Medical power of attorney | Living will |
|---|---|---|
| Main job | Names who decides for you | States treatment preferences in writing |
| When it matters | When you cannot make health decisions | Often end-of-life or specified scenarios |
| Flexibility | Agent can respond to new situations | Fixed written instructions |
| Best used | Anyone who wants a decision-maker | People with clear treatment limits or goals |
Use this medical POA to appoint your decision-maker. Pair it with a living will or advance directive when you want written treatment preferences on file. This medical form does not authorize financial acts.
Who to name as your health care agent
Choose someone who:
- Will advocate for your values under stress
- Can talk clearly with doctors and family
- Is willing to serve and keep your wishes private when appropriate
- Meets your state’s eligibility rules (many states bar treating providers, facility operators, or certain employees from serving)
Name at least one backup agent if your primary cannot serve. Tell your agent what matters to you (pain control, quality of life, religious limits, organ donation) so the document and the conversation work together.
What's included in this medical POA template
Your guided form covers:
- Principal identity and contact details (including state)
- Health care agent and optional backup agents
- Scope of authority: treatment decisions, facility choices, mental health treatment options, feeding tubes, pregnancy-related limits where applicable, and access to medical records
- Special instructions and limitations
- Post-death options some states allow (autopsy, organ donation, final disposition) when you enable them
- Execution: two witnesses and/or notary acknowledgment, with state-aware branches in the document
State rules to check before you sign
Health care proxy rules are set by your state, and they differ in ways that matter: how many witnesses you need, who is disqualified from witnessing, and whether a notary is required.
You enter your state in the form and the document adjusts. Three things worth confirming yourself:
- Whether your state wants two witnesses, a notary, or both
- Who cannot witness for you (often your agent, close relatives, and anyone paid to care for you)
- Whether your state publishes its own official form that hospitals there prefer
Your state health department is the best place to check, and your state attorney general's consumer pages often explain the same rules in plain language.
How to prepare your medical power of attorney
Name your health care agent and backups
Pick a primary agent you trust with treatment decisions, plus backups. Confirm each person is willing to serve and knows how to reach your doctors.
Set the scope of authority
Decide whether your agent may access medical records, consent to or refuse treatments, choose facilities, and handle any special limits you want in writing.
Add special instructions
Write plain-language limits or priorities that match any living will you already have. Keep the medical POA and living will consistent.
Execute with witnesses and/or a notary
Sign while you have capacity. Many states require two qualified witnesses, a notary, or both. Follow the path the form shows for your state, then give copies to your agent and primary care provider.
Review after life changes
Update the form after marriage, divorce, a move, a new diagnosis, or if your chosen agent can no longer serve.
How it works on Doqu
- Answer simple questions about parties, powers, instructions, and signing details.
- Preview free so you can read the full medical power of attorney before you download.
- Download as PDF or Word when you are ready to print, witness, notarize, or share.
- Complete in-person witness or notary steps your state still requires.
Free to start; download when you are ready. Keep a signed copy with your agent and another with your medical records.
Related estate planning documents
Explore more in the Estate Planning category.
- Power of Attorney: financial and legal POA (ordinary or durable)
- Durable Power of Attorney: financial POA that continues after incapacity
- Living will / advance directive: written treatment preferences (related; use your state’s health care forms when available)
A complete plan often pairs a medical POA with a living will and a durable financial POA.
Frequently asked questions
Sample document preview
This page includes a sample Medical Power of Attorney with blank answer lines. Names, dates, and other details are intentionally left unfilled so you can see the document structure.
Downloadable sample PDF and Word files include only the first 2 pages, plus a final page with a link to create the full document on Doqu. They are not complete, usable legal documents.
To complete this document: use the Doqu editor to answer guided questions. Your live preview updates as you fill in each field, then you can download or send the document for e-signature.
Download the sample files below to review layout and clause structure before you start.
Medical Power of Attorney — other states
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