Legal Delaware Medical Power of Attorney Template Edit Document Online

Legal Delaware Medical Power of Attorney Template

A Medical Power of Attorney in Delaware allows a person to appoint someone they trust to make healthcare decisions on their behalf if they're unable to do so themselves. This legal document ensures that the individual's healthcare preferences are respected, even when they can't communicate their wishes. It's a crucial step in planning for future medical care, providing peace of mind for both the person and their loved ones.

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When an individual faces medical decisions and is unable to express their wishes, the Delaware Medical Power of Attorney form becomes a vital legal document. This form empowers another person to make healthcare decisions on behalf of the individual, ensuring that their medical care aligns with their preferences. It covers various aspects, including the types of medical treatments the individual agrees to, the ones they wish to avoid, and the values or beliefs that should guide these decisions. The designated agent, chosen by the individual, is granted the authority to discuss medical issues with healthcare professionals and make decisions that can range from routine to life-sustaining treatments. It’s important to note that this form requires careful consideration and clear communication between the individual and their chosen agent to ensure that decisions made reflect the individual’s desires. By understanding the full scope and implications of the Delaware Medical Power of Attorney form, individuals and their families can feel more secure in the knowledge that healthcare choices will be respected, even when direct communication is not possible.

Document Example

Delaware Medical Power of Attorney

This Medical Power of Attorney document grants authority to an appointed person (Agent) to make healthcare decisions on behalf of the Principal when the Principal is unable to make decisions for themselves. This document is in accordance with the Delaware Advance Health Care Directive Act.

The effectiveness of this document is contingent upon the recognition of the Principal's incapacity to make healthcare decisions, as determined by a licensed physician. The appointed Agent will possess the authority to make a wide range of health care decisions unless limitations are specified within this document.

Principal Information

Full Legal Name: _________________________

Date of Birth: _________________________

Address: _________________________

Agent Information

Full Legal Name of Agent: _________________________

Relationship to Principal: _________________________

Primary Phone: _________________________

Alternate Phone: _________________________

Address: _________________________

Alternate Agent Information (If any)

Full Legal Name of Alternate Agent: _________________________

Relationship to Principal: _________________________

Primary Phone: _________________________

Alternate Phone: _________________________

Address: _________________________

Authority of Agent

The Agent is authorized to make all forms of healthcare decisions on behalf of the Principal that the Principal could make, including but not limited to:

  • Consenting or refusing medical treatment.
  • Access to medical records.
  • Deciding on the Principal's residence for health care provisioning.

Special Instructions

To limit the authority of the Agent or to specify desired healthcare treatments, document the instructions below:

Special Instructions: _________________________

Signature

By signing this document, the Principal confirms their understanding of its contents and their voluntary decision to grant authority to the Agent named herein. This Medical Power of Attorney becomes effective when the Principal is determined to be unable to make health care decisions for themselves.

Principal's Signature: _________________________Date: ________________

Agent's Signature: _________________________Date: ________________

Witness Declaration

This document was signed in the presence of the undersigned witnesses, who affirm that the Principal appears to be of sound mind and not under duress, fraud, or undue influence.

Witness 1 Signature: _________________________Date: ________________

Witness 1 Printed Name: _________________________

Witness 2 Signature: _________________________Date: ________________

Witness 2 Printed Name: _________________________

Notarization (If required)

This section to be completed by a licensed notary public.

State of Delaware )

County of _______________ )

Subscribed and sworn before me on this _____ day of ____________, 20__.

Notary Public Signature: _________________________

Printed Name of Notary: _________________________

My commission expires: _________________________

Form Attributes

Fact Name Description
Governing Law Delaware Code Title 16, Chapter 25: Delaware Advance Health-Care Directive Act
Definition A legal document that allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to do so.
Requirements The form must be signed by the principal (individual granting the power), in the presence of a notary or two witnesses who are not related to the principal, not the designated agent, and not directly involved in the principal’s healthcare.
Revocation The Delaware Medical Power of Attorney can be revoked by the principal at any time, in any manner that communicates intent to revoke, regardless of the principal's mental state.

Instructions on Utilizing Delaware Medical Power of Attorney

Filling out a Delaware Medical Power of Attorney (MPOA) form is a crucial step in managing your healthcare decisions if you're unable to do so yourself. This document allows you to name someone, often called an "agent," who can make medical decisions on your behalf. Here's how to accurately complete the form to ensure your healthcare wishes are followed:

  1. Start by reading the form carefully. Understanding each section is essential for accurately conveying your healthcare preferences and for choosing the right person as your agent.
  2. Fill in your full legal name and address at the top of the form. This identifies you as the principal—the person granting decision-making authority.
  3. Choose your agent wisely. Your agent should be someone you trust wholly with your health care decisions. Write the name, address, and contact number of your chosen agent in the designated section.
  4. If desired, select an alternate agent. This person will make decisions if your primary agent is unavailable. Include the alternate agent’s contact information just like you did for your primary agent.
  5. Detail the powers you are granting to your agent. Be as specific as possible regarding what your agent is allowed and not allowed to do. This can include decisions about specific treatments, access to medical records, or end-of-life care.
  6. Discuss your healthcare preferences with your agent. Although this is not a form-filling step, having a conversation about your values and wishes is vital. It ensures your agent can make decisions that align with your preferences.
  7. Sign and date the form. Your signature officially activates the MPOA. Ensure you do this in the presence of the required witnesses or a notary, depending on Delaware’s requirements.
  8. Have the required number of witnesses sign the form. Delaware law might require witness signatures to ensure the form's validity. Check the current legal requirement for the exact number of witnesses needed.
  9. Finally, distribute copies of the completed form. Give one to your agent, one to your alternate agent (if applicable), and keep a copy for yourself. It is also wise to provide a copy to your primary healthcare provider.

Completing your Delaware Medical Power of Attorney is a proactive step in healthcare planning. It not only protects your wishes but also alleviates potential burdens on your loved ones. Remember, it’s equally important to review and potentially update this document periodically, especially after significant life changes.