9000354 Appointment of Patient Advocate9000354 Durable Power of Attorney.qxd 2026

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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