Medical Power of Attorney California Form – PDF

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.
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A 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