MEDICAL POWER OF ATTORNEY
THIS MEDICAL POWER OF ATTORNEY is made on this [Date] day of [Month], [Year].
BY
[Full Name of the Principal],
S/o or D/o [Father's or Mother's Name],
Resident of [Full Address],
(hereinafter referred to as the "Principal").
IN FAVOUR OF
[Full Name of the Agent],
S/o or D/o [Father's or Mother's Name],
Resident of [Full Address],
(hereinafter referred to as the "Agent").
WHEREAS:
1. The Principal is of sound mind and legally competent to execute this Medical Power of Attorney.
2. The Principal desires to appoint the Agent to make healthcare decisions on their behalf in the event that the Principal is incapacitated and unable to make such decisions.
NOW, THEREFORE, the Principal hereby appoints the Agent as their lawful attorney-in-fact to make medical decisions on their behalf as follows:
The Agent shall have the full power and authority to make all healthcare decisions for the Principal, including but not limited to:
- Consenting to or refusing medical treatments.
- Selecting and discharging healthcare providers and institutions.
- Approving or denying diagnostic tests, surgical procedures, and other treatments.
- Making decisions regarding life-sustaining treatments.
- Accessing the Principal’s medical records and disclosing them to appropriate parties.
This Medical Power of Attorney shall become effective only upon the Principal's incapacitation, as determined by a qualified medical professional.
This Power of Attorney shall remain in effect until revoked by the Principal or upon the Principal's death.
The Principal may revoke this Medical Power of Attorney at any time by providing written notice to the Agent and any relevant healthcare providers. Such revocation shall be effective upon receipt.
The Agent is legally obligated to act in the best interest of the Principal and to make decisions in accordance with the Principal's known wishes or, if such wishes are unknown, in a manner consistent with the Principal's best interest.
In the event that the Agent is unable or unwilling to act, the Principal hereby appoints [Full Name of Alternate Agent],
Resident of [Full Address],
as an alternative Agent with the same powers and responsibilities.
This Medical Power of Attorney is executed in the presence of the following witnesses, who attest that the Principal is of sound mind and is acting voluntarily, without duress or undue influence.
Witness 1:
Name:
Address:
Signature:
Witness 2:
Name:
Address:
Signature:
IN WITNESS WHEREOF, the Principal and Agent have executed this Medical Power of Attorney on the day and year first above written.
Principal's Signature:
[Full Name of the Principal]
[Signature]
Agent's Signature:
[Full Name of the Agent]
[Signature]
NOTARIZATION (If Required)
(Notary's Seal and Signature)