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Durable Power of Attorney

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Durable Power of Attorney

File Type: Word      Price: $9.99        


Summary: A durable power of attorney for health care agreement gives a relative, friend or a bank the power to act for you should you become disabled or unable to act for yourself. An ordinary power of attorney is automatically suspended or revoked (it is no longer valid) if you become incompetent - just when your family would need it most. The states responded to the problem by creating the "Durable Power of Attorney" which is a power of attorney that remains in effect even if you become disabled. Use this durable power of attorney form to formally document healthcare wishes in the event of disablement.


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I, _____________________________________________________________________ , am of sound mind, and I voluntarily (Print or type your full name) make this designation.

I designate _____________________________________________________________________________________ , my  (insert name of patient advocate) ___________________________________________________ ,

(Spouse, child, friend ... ) living at  _______________________________________________________________as my patient advocate. 

My patient advocate or successor patient advocate shall have power to make care, custody and medical treatment decisions for me in the event I become unable to participate in medical treatment decisions. I understand my patient  advocate must sign an acceptance before he or she can act. I have discussed this appointment with the individual or individuals I have designated.


The determination of when I am unable to participate in medical treatment decisions shall be made by my attending physician and another physician or licensed psychologist.

In making decisions for me, my patient advocate shall endeavor to follow my previously expressed wishes, whether I have stated them orally, in a living will, or in this designation. 

My patient advocate has authority to consent to or refuse treatment on my behalf, to arrange medical and personal services for me, including admission to a hospital or nursing care facility, and to pay for such services with my funds. 

My patient advocate shall have access to any of my medical records to which I have a right. 


I expressly authorize my patient advocate to make decisions to withhold or withdraw

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