Medical Power of Attorney California Form – Adobe PDF

License / Price: Free
Version: Adobe PDF (.pdf)
File size: 95 KB
Use this Form to: Handle another person's medical decisions in the unfortunate situation where he or she cannot make them.

The California medical power of attorney, also known as an “Advance Directive”, is used to represent another’s health care decisions in a situation where a person may not be able to represent themselves. In addition, there is a portion called a living will that allows the principal to choose life-ending procedure options (such as withholding mechanical respirators or the intake of food and liquids). 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.

Laws§ 4701 (Advance Health Care Directive Forms)

Signing Requirements – The POA must be signed before a notary public or two (2) witnesses (§ 4701(e)).

Registering a Medical Power of Attorney

One must take the completed Medical Power of Attorney and a filled out Registration Application (Form SFL-461) and attach to them a check in the amount of $10 made payable to the “California Secretary of State.” The package can then be sent to the below address.

Secretary of State, Special Filings Unit, P.O. Box 942870 Sacramento, CA 94277