Medical Power of Attorney Illinois Form – PDF

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An Illinois medical power of attorney form enables an individual to designate someone as their health care agent. This agent will be able to make health care related decisions on behalf of the individual when they have lost the ability to communicate their wishes.

The loss of decisional capacity must be determined by a licensed physician; only then can the health care agent step in. Generally speaking, it is a close family member such as a spouse or child that will be selected as the principal’s health care representative as they will have a firm grasp on the patient’s philosophy with regard to life-sustaining treatments and procedures.

Laws755 ILCS 45/Art. IV

Signing requirements – Must be signed by the principal and one (1) adult witness (755 ILCS 45/4-5.1).