Free blank printable medical power of attorney forms

An enduring power of attorney allows you to appoint someone you trust to make decisions for you and continues if you lose capacity to make decisions yourself.

An advance health directive allows you to give directions about your future healthcare. You can also use this form to appoint an attorney(s) for health matters.

A general power of attorney allows you to appoint someone you trust to make financial decisions for you while you have capacity to make those decisions but ends once you lose capacity to make those decisions (unless it is a power of attorney given as security).

Explanatory Guides

You should refer to the enduring power of attorney explanatory guide or the advance health directive explanatory guide while you complete the forms. They step you through the questions and provide useful information, practical examples, hints and tips. See also the Queensland Capacity Assessment Guidelines 2020.

These are important legal documents that can significantly affect your legal rights. It is recommended that you seek independent legal advice before completing these.

For more information go to www.qld.gov.au/guardianship-planahead.

Copies of forms

Paper copies are available to purchase from many newsagents or other stationery suppliers throughout Queensland. You could also print a copy of the forms at your local library or access a print on demand service.

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A medical power of attorney, or sometimes a ‘health care proxy’, is a form designated to allow an individual, known as the ‘principal’, to be able to choose someone else, known as the ‘agent’ or ‘attorney-in-fact’, to carry out health care decisions that are in line with their beliefs.

Any decisions being made by the agent may only be in effect when the principal is not in a state of mind to make them for themselves. Usually the form must be witnessed by at least two (2) people, none of which can be family, or a notary public depending upon the State’s law. Once complete the form should be distributed and given to any and all primary care physicians, family members, and close friends.

Updated July 27, 2022

A medical power of attorney form (MPOA) allows a person (principal) to select an agent to make health care decisions on the principal’s behalf. The agent’s powers are effective after the principal becomes incapacitated or cannot make decisions on their own.

When making decisions, the agent must follow the principal’s preferred treatment options written in their Living Will (included in the MPOA).

By State

What is a Medical Power of Attorney?

A medical power of attorney (MPOA) is a designation made to select a person (agent or attorney-in-fact) to make health care decisions on behalf of someone else (principal).

If there is a dispute on whether the principal can make their own decisions, it will only go into effect after a licensed physician has deemed the principal incapacitated.

It’s recommended for a person that makes a medical power of attorney to also create a living will to write their treatment preferences for an agent to follow.

Medical POA vs Living Will

A medical power of attorney lets a person select their preferred treatment options with the use of choosing an agent to carry out their wishes. The agent will have full authority to make any type of decision to prolong or withdraw life-sustaining treatment.

A living will allows a person to select their preferred treatment options without the use of an agent. A living will directs medical staff their intentions to prolong or withdraw life-sustaining treatments depending on their condition.

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Statutory Forms

Signing Requirements

A witness cannot be a person that is related to the principal, agent or be a beneficiary in the principal’s last will and testament. If a notary is required, the notary may not act as a witness.

The Agent that you select will have the responsibility of making your decisions based on your health care situation. Therefore you will want someone that you trust and is aware of your basic medical history (such as heart conditions, medication, allergies, etc.)

• Successor (2nd) Agent – Individual selected only if the primary agent is not able to fulfill their duties. Co-agent authority is not usually allowed, must be the decision of 1 person.
• Compensation – You have the option to set up compensation for the agent selected for lodging, food, and travel costs.

Step 2 – Agent’s Decisions

The decisions you give your agent related to your health care is up to you. You can allow your agent to make any type of decision that presents itself or you could limit your agent to only certain types of decision making. The more detailed you are as to what your agent can and cannot do will enhance the medical staff on your health intentions.

• Example –  Requesting the agent to refuse life support if there is little to no chance of a full recovery.

The following powers of the agent should be written:

• Surgical Treatments
• Nursing Home Treatment/Care
• Hospitalization
• Medical Treatment
• Psychiatric Treatment
• HomeStay Care
• Organ Donation
• End of Life Decisions

Step 3 – Attach a Living Will

A living will is a highly recommended option to be attached to any medical power of attorney. In addition to having someone speak on their behalf, a living will outlines a person’s end-of-life treatment selections.

For example, if a person should become in an incapacitated state with no chance for a cure, they can select to withhold life-sustaining methods to keep them alive. In addition, it allows the selection for organ donation and other post-death options.

Step 4 – Sign & Complete

The principal and Agent must sign in accordance with their respective State Signing Laws. In most cases, the form may be signed in the presence of two (2) witnesses or notary public, and sometimes both. After this has been legally authorized the document becomes valid to be used. The principal must be thinking freely during the creation of this form.

The Agent should carry an original copy of their form and will most likely need to present it during every occurrence. It is recommended to give a copy of this form to your primary care physician.

How to Write a Medical POA

Download in Adobe PDF (.pdf), Microsoft Word (.docx), or Open Document Text (.odt).

Step 1 – In Section I (Appointment of Health Care Agent) the principal and Agent full name and address. At the bottom of the section, the home phone, work phone, cell phone, and e-mail of the agent should be written.

Step 2 – In Section II the principal should include any exceptions (if any) from the broad powers the agent will have.

Step 3 – In Section III, the principal has the option of selecting up to two (2) alternate agents in the chance individuals are unavailable for an act for the principal.

Step 4 – In Section IV list the locations where originals and copies of this document will be held.

Step 5 – In Section V, if the power of attorney will have an end period check the box and initial with the date that the form expires.

Step 6 – On the last two (2) pages the individuals listed should sign the form in the presence of a notary public and/or two (2) witnesses that are not in any way connected (blood/marriage) with the parties authorizing the form.

All parties of the document must be present with the Notary Public.

If the State requires two (2) witnesses then the Witness Acknowledgment must be signed on the last page.

Related Forms

Download: Adobe PDF, MS Word, OpenDocument

Download: Adobe PDF, MS Word, OpenDocument

Download: Adobe PDF, MS Word, OpenDocument