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Advanced Directive

Establish an Advanced Directive and appoint a Medical Power of Attorney or Healthcare Proxy.

Establish an Advanced Directive and appoint a Medical Power of Attorney or Healthcare Proxy.

An Advanced Directive or Health Care Directive allows a person to plan treatment options and select an agent to make medical decisions on their behalf. This document is used when you are no longer able to make decisions for yourself (e.g., dementia, Alzheimer’s disease, unconsciousness, etc.)

NOTE: Every state is different in what they require to be included in Power of Attorney and/or Advanced Directives, so research and find out what is required in your state so that you do not give the facility or medical provider any reason to reject your documents.

A Medical Power of Attorney (MPOA), or Healthcare Proxy, allows a person to select an agent to make health care decisions on their behalf. This agent’s powers go into effect only after the person is considered unable to make their own decisions (incapacitated). The agent selected must follow the principal’s preferred treatment options as written in their Advanced Directive.

Talk with your family, friends, and physicians about your advance directive. Be sure your healthcare proxy, understands your wishes.

Be as specific as necessary to express your wishes for care such as:


Print, sign, date and photocopy the form. Feel free to have it notarized if you want to make it even more official, but this isn’t necessary.

Provide a copy to your MPOA/health care proxy, your family, friends, health care providers, and/or faith leaders so that the form can be readily available in the event of an emergency. Make sure it is posted in your home, or kept in your car, in an area that would be easily accessed by emergency personnel, such as posted to your refrigerator, in your vehicle’s center console, in your wallet, etc.

There is a myriad of free or low-cost Medical Power of Attorney and Advanced Directive forms to be found online. Spend some time reading different ones and find one that you are comfortable with and that fits your needs. Below are a couple of online resources, but there are MANY out there, so search until you find one you like.

Establish an Advanced Directive and appoint a Medical Power of Attorney or Healthcare Proxy.

Free online legal forms by State:

Medical Power of Attorney (MPOA) Form

Medical Power of Attorney (MPOA) Form

If you are hospitalized and do not have an AD already pre-loaded in your medical chart, or asked to sign a consent for treatment form, have that consent form printed out. DO NOT SIGN the general electronic version provided to you by the hospital. You can customize its contents on the printed version, crossing out and adding declarations as needed, such as those noted above (NO VENTILATORS, NO REMDFESIVER,…). Then sign and date the updated form and return it to the hospital.

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