Medical Power of Attorney California Form – Adobe PDF

License / Price: Free
Version: Adobe PDF (.pdf)
File size: 56 Kb
Use this Form To: Handle another person's medical decisions in the unfortunate situation where he or she cannot make them.
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Most commonly used to represent another’s health care decisions in situation where a person may not be able to represent themselves. The Principal must be in a clear mental state before selecting their agent. This document is very common before risky surgery or for elderly family members.

The California Advance Health Care Directive is composed of two parts: the Living Will and the Durable Power of Attorney for Health Care.

In the Living Will, you state what types of medical procedures you consent to, and under what conditions you give that consent. You can also specify what you don’t want done. This will prevent doctors, courts, and people unfamiliar with you and your values from making those decisions for you.

The Living Will can’t, of course, anticipate every eventuality. That’s where the Durable Power of Attorney For Health Care comes in. With this document, you name a person to make healthcare decisions for you when you are no longer able to. The designated person is called your Agent. Generally chosen are spouses, close friends, or relatives. It can’t be your doctor or persons employed in certain types of health care. It is important that the Agent is able to physically get to your bedside when needed, as he or she will need to meet face to face with providers. He or she must be persistent, articulate, and must be able to forcefully advocate for your values even in the face of honest opposition.

Registering a Medical Power of Attorney

Gather the completed health care power of attorney form along with the registration application (May also be used to add an amendment or revoke a previous power of attorney) and a check for $10 made payable to the State.

Send to:

Secretary of State, Special Filings Unit, P.O. Box 942877, Sacramento, CA 94277-0001 (916) 653-3984


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