9000354 Appointment of Patient Advocate9000354 Durable Power of Attorney.qxd 2025

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  1. Click ‘Get Form’ to open it in the editor.
  2. Begin by entering your full name and complete legal address in the designated fields for the appointment of your patient advocate.
  3. Next, provide the name and address of the person you wish to appoint as your patient advocate. If this person cannot serve, fill in the details for a second advocate.
  4. In Section II, review and check the boxes that grant authority to your advocate regarding medical decisions, including access to records and treatment options.
  5. Section III allows you to express your desires regarding life support. Carefully select your preferences for each scenario presented.
  6. Sign and date the document in Section IV, ensuring that witnesses also sign as required.
  7. Finally, confirm acceptance from your appointed advocates in Section V by having them sign and date their acceptance.

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A medical power of attorney, also called a durable power of attorney for health care, is a legal document. In it, you grant another person the authority to make medical decisions for you if you become unable to do so. The person you choose is your health care agent (health care proxy, health care surrogate).
A durable power of attorney remains in effect even after you are mentally incapable of making your own healthcare or financial decision. We recommend having both a durable power of attorney for health care and a durable financial power of attorney to ensure optimal management of your health as well as your assets.
Most states provide blank POA forms for free, which the grantor can fill out and sign. Your grantor can also use free online software, like FreeWill, to create a durable financial power of attorney, or a living will (which includes a healthcare power of attorney).
Choosing between durable and general depends on what you need for the future. We suggest talking to an estate planning lawyer to see which one is right for you. In short, durable powers of attorney give better protection if someone cant make decisions and keep decision-making going.
NOTICE: The purpose of this power of attorney is to give the person you designate (your agent) broad powers to make health care decisions for you, including power to require, consent to, or withdraw any type of personal care or medical treatment for any physical or mental condition and to admit to or discharge you from
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One major downfall of a POA is the agent may act in ways or do things that the principal had not intended. There is no direct oversight of the agents activities by anyone other than you, the principal. This can lend a hand to situations such as elder financial abuse and/or fraud.
A health care power of attorney only allows your agent to make medical decisions on your behalf, while a durable power of attorney grants your agent broader powers in financial and personal matters.
A Durable Power of Attorney for Health Care is a document that lets you name someone else to make decisions about your health care in case you are not able to make those decisions yourself. It gives that person (called your agent) instructions about the kinds of medical treatment you want.