Fill out the form listed below:

• Power of Attorney for Health Care: This program will help you fill out a power of attorney for health care.

Note: Do not sign the power of attorney for health care until Step 3. You do not need to make copies of this form until Step 4.

After you have filled out the form, print out the document, then:

• Read your document carefully to be sure that you understand it and agree with what is written.
• Write your initials next to the X’s which mark the choices you made on each page.

Next, you will need to find at least one witness. If possible, you should find two witnesses. The witness must be at least 18 years old and be mentally competent. Sign the form in front of the witness or witnesses, and ask the witness or witnesses to sign it too.

Effective January 1, 2024, electronic signatures are permitted in certain documents which create, exercise, release, or revoke a power of attorney. A notary or witness must be "electronically present" to electronically sign. Electronic presence could be over a video service like Zoom.

The witness must not be:

• Your doctor or health care provider, or a close relative of your doctor or health care provider,
• A person you listed as an agent or successor agent in the document, or a close relative of your agent or successor agent,
• An owner or operator of the health care facility where you are a patient or resident, or a close relative of that owner or operator, 
• A person who helped you write the document, or 
• Your close relative.

The person you give the power of attorney to is the agent and you are the principal. The agent is usually a spouse, a close friend, or a trusted relative.

The document does not have to be notarized. But it is a good idea to have it notarized if possible.

Once the power of attorney is signed, make multiple copies. Give one copy to your primary medical doctor. Also, give copies to other health care providers who you see regularly. If you live in a nursing home or assisted living facility, give a copy to the administrator. If you go to the hospital, take a copy with you.

If you don't think your agent will need to use the power of attorney any time soon, keep the original and give your agent and each of your successor agents a copy. Be sure to tell your agent where to find the original. If you are already sick, or think your agent might need to use the power of attorney soon, you can give your agent the original, but be sure to keep a copy for yourself.

Your health care provider will contact your agent if you become too sick or injured to make your own decisions. Your agent must bring a copy of the power of attorney document to the health care provider treating you. The health care provider won't listen to your agent without the document.