In addition to a power of attorney, many people create a living will. A living will allows you to describe your healthcare wishes in case of incapacitation. Medical powers of attorney and living wills are both advance directives for health care. You can view our living will template here.
This Medical Power of Attorney is effective from its execution and will remain in force indefinitely unless revoked. I understand I cannot revoke this document when I am considered incompetent to make my own decisions.
(If applicable initial and check)
This power of attorney shall expire on (insert number) day of (insert month), 20 (insert number)
My signature below shows that I understand the purpose and reason for this document. By signing this document, I revoke and cancel all prior Medical Durable Powers of Attorney that I may have previously created:
We, the undersigned witnesses, do at this moment declare under penalty of perjury that we have witnessed the Principal whose name, identity, and handwriting are known to us signing and executing this Medical Power of Attorney in our presence.
Further, we declare that we are not related to the Principal by blood nor by marriage nor by adoption, nor are we involved in providing medical treatment to the Principal nor are we beneficiaries under the Principal's Last Will and Testament and that the Principal appears, in our best judgment, to be acting in sound mind, voluntarily and free from external influences, stress, duress, and undue influence.