Medical Power of Attorney Form
A medical power of attorney form is used by a client when they wish to give an attorney power and authority to handle matters such as making decisions in case they become incapacitated due to medical reasons. The medical power of attorney explains when and how the attorney should act in event of such an incident. The document below is a sample medical power of attorney form.
Sample Medical Power of Attorney Form
I (Name of client) _____________________, (Address) ___________________ appoint
(Name of lawyer) ____________________________ of
(Address)___________ (4) _______________ as my attorney. I hereby transfer my authority and rights to the undersigned attorney to make decisions on my behalf whenever am incapacitated as a result of medical related reasons.
(Description of extent of authority)
The appointed party shall have the rights and powers to make decisions on my behalf as described by the client as from _________________ and shall act in that capacity them until___________________ with exception of an extension or prior notice of termination by either party.
Dated _________________Sign _________________________
The authority in this mater hereby appoints me as the attorney he grants full authority and power to act on his behalf concerning the described matter as from ________________________in person and in full knowledge.
Sign__________________ Date_____________________
Commission of Expiry _________________________
Category: Power of Attorney forms
