Ask A Question
Business Forms
Business Directory

Medical Power of Attorney Form

Business Network Members
  1. A1 Energy Inc
  2. EC Stryker, Inc
  3. Smoky Shadow
  4. GEMS Bookkeeping Services

Medical Power of Attorney

Word   PDF  

Medical Power of Attorney

Effective Date ____/____/______

I, do hereby [Legal Name]
A resident of [City][State]
Located at [Address]
[City], [State] [Zip Code]

Do Hereby Appoint [Legal Name]
A resident of [City][State]
Located at [Address]
[City], [State] [Zip Code]

As my attorney-in-fact to make any and all health care decisions for me, except to the extent I state otherwise in this document. This Medical Power of Attorney takes effect if I become unable to make my own health care decisions and my physician certifies this fact in writing. The following are limitations on the decision making authority of my agent:





If the above designated person as my agent is unable or unwilling to make healthcare decisions for me, I hereby designate the following persons to serve as my agent to make health care decisions for me as is authorized by this document, who may serve in the following order:

First Alternate:

Do Hereby Appoint [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

Second Alternate:

Do Hereby Appoint [Legal Name]

A resident of [City][State]

Located at [Address]

[City], [State] [Zip Code]

This power of attorney is to start to be effective on ____/____/______, and shall remain effective until ____/____/______. If I am unable to make health care decisions for myself when this power of attorney expires, the authority I have granted my agent continues to exist until the time I become able to make health care decisions for myself. I hereby revoke any prior Medical Power of Attorney that I have made in the past. I do hereby grant my attorney-in-fact complete and full authority to act in any reasonable and necessary manner for the purpose of exercising the above mentioned powers. I also, ratify all the lawfully performed acts by my attorney-in-fact in exercising those powers. I fully understand and agree that any third party who is given a copy of this Power of Attorney may act relying on it. I also, agree that revocation of this Power of Attorney is effective as to a third party only when they receive receipt of an actual notice by the third party. If due to reliance on the Power of Attorney, a third party suffers any loss, I agree to pay for any third party loss.

I sign my name to this Medical Power of Attorney on:

____________ Day of ____________ Month ____________ Year


By accepting this appointment and acting under it, I the attorney-in-fact (“Agent”) do hereby assume the legal responsibilities of an agent.

Signature of Attorney-in-Fact

WITNESS #1) _________________________________

WITNESS #2) _________________________________

Business Network Members
  1. Perfect Yard Company LLC
  2. Adolutions
  3. Clear Concepts Commercial Cl
  4. MEGAplus Courier Services, I

Power Of Attorney

Power Of Attorney Template

Revoke Power of Attorney

Limited Power of Attorney

Financial Power of Attorney

Medical Power of Attorney

Durable Power Of Attorney

Special Power of Attorney

Lasting Power Of Attorney

Guardianship Power of Attorney

Power Of Attorney Assortment

State Power Of Attorney

Alabama Power of Attorney

Alaska Power of Attorney

Arizona Power of Attorney

Arkansas Power of Attorney

California Power of Attorney

Colorado Power of Attorney

Connecticut Power of Attorney

Delaware Power of Attorney

District of Columbia Power of Attorney

Florida Power of Attorney

Georgia Power of Attorney

Hawaii Power of Attorney

Idaho Power of Attorney

Illinois Power of Attorney

Indiana Power of Attorney

Iowa Power of Attorney

Kansas Power of Attorney

Kentucky Power of Attorney

Louisiana Power of Attorney

Maine Power of Attorney

Maryland Power of Attorney

Massachusetts Power of Attorney

Michigan Power of Attorney

Minnesota Power of Attorney

Mississippi Power of Attorney

Missouri Power of Attorney

Montana Power of Attorney

Nebraska Power of Attorney

Nevada Power of Attorney

New Hampshire Power of Attorney

New Jersey Power of Attorney

New Mexico Power of Attorney

New York Power of Attorney

North Carolina Power of Attorney

North Dakota Power of Attorney

Ohio Power of Attorney

Oklahoma Power of Attorney

Oregon Power of Attorney

Pennsylvania Power of Attorney

Rhode Island Power of Attorney

South Carolina Power of Attorney

South Dakota Power of Attorney

Tennessee Power of Attorney

Texas Power of Attorney

Utah Power of Attorney

Vermont Power of Attorney

Virginia Power of Attorney

Washington State Power of Attorney

West Virginia Power of Attorney

Wisconsin Power of Attorney

Wyoming Power of Attorney

Certification of Trust

Agreements & Notices

Independent Agreements
Letter of Agreement
Public Notary Forms
Finder's Fee Contract
Shareholder Agreement
Agreement of Sale
Sublease Agreement
Vacation Rental Agreement
Photo Copyright Release
Audit Engagement Letter
Roommate Rental Agreement
Sworn Affidavit Agreement
Certificate of Title
Money Wire Transfer Form
Last Will And Testament
Escrow Agreement

Change Contracts
Letter To Terminate A Contract
Change Of Contract Terms
Addendum To An Existing Contract
Notice of Cancellation of Contract
Breach of Contract Forms
Letters to End a Contract
Addendum To Agreement of Sale

Power Of Attorney
Power Of Attorney Template
Revoke Power Of Attorney
Limited Power Of Attorney
Durable Power Of Attorney
Medical Power Of Attorney
Financial Power Of Attorney
Guardianship Power Of Attorney
Special Power Of Attorney
Lasting Power Of Attorney
Certification of Trust
Power of Attorney Assortment

Contractor Agreements
Independent Contractor
Lawyer Retainer
Consulting Retainer
Model Release
Photography Release
Application for Contractor Approval

Business Operations
Change Of Address Form
Business Closure Letter
Franchise Disclosure
Invention Disclosure

Rental Equipment
Equipment Maintenance
Equipment Lease Forms
DJ Equipment Rental Contract
Car Rental Agreement
Rental Lease Agreement *
Tenant Screening Form *
Key Receipt *
Short Lease Agreement *

Environmental Disclosures
Mold Addendum Lease Terms
Mold Disclosure Agreement
Lead Paint Disclosure Agreement
Asbestos Disclosure Agreement

Warranty & Liability
Business Liabilities Worksheet
Free Liability Release Forms
Warranty Agreement
Stop Notice Agreement
Contract of Indemnity
Volunteer Waiver
Cosigner Agreement
Cease Collection Letter
Prevent Identity Theft
Business Fraud Checklist
Subpoena Form
Small Claims Court Forms

Lien Notices
Preliminary Lien Notice
Release of Lien Agreement
Claim of Lien Notice
Proof of Service
Mechanics Lien Agreement
Mechanic's Lien Waiver
Attorney Lien

Home - Sign In - Contact - Privacy Policy - Business Assistant - Ask A Question - Business Directory - Marketing Trends - Business Forms - Starting A Business - Business Ideas - Service Contracts - Agreements & Notices - Vehicle & Transportation - Attendance & Scheduling - Organize & Communicate - Hiring An Employee - Employee Performance - Training & Coaching - Continuous Improvement - Sales, Bids & Estimates - Payroll & Accounting - Purchasing & Receiving

© Copyright 2015