How is this different from a financial POA?

A financial POA covers money and property — banking, real estate, investments, taxes. A healthcare POA covers medical treatment decisions only. The two are separate documents and require separate signatures. Most banks will not accept a healthcare POA for financial transactions, and most hospitals will not accept a financial POA for medical decisions. You need both.

Does the agent need to live in the same state?

Not legally, but practically yes — agents need to be reachable in an emergency. A long-distance agent can usually act by phone for routine decisions, but in-person presence is often important for complex end-of-life choices. Name a closer alternate if your primary is far away.

Can the agent override my doctor?

The agent stands in your shoes — meaning the agent has the same right to consent to or refuse treatment that you would have. Doctors can recommend, but cannot force, treatment over the agent's objection in most cases. Disputes between agent and family or between agent and physician sometimes go to court or hospital ethics committees; clear documentation of your wishes minimises these.

Should the document be notarised, witnessed, or both?

State law varies. Most states require either two witnesses OR notarisation; some require both. Witnesses generally cannot be the agent, the alternate, the attending physician, or anyone who would inherit from your estate. Using both witnesses AND a notary is the safest path — it satisfies every state's requirement and minimises hospital pushback.

What happens if I move to a different state?

Most states honour out-of-state healthcare POAs validly executed where signed, but the local form is more likely to be followed without question. If you have moved permanently, re-execute under the new state's form. Your old document is not "void" but may face friction at the bedside.

Healthcare Power of Attorney

Appoints a healthcare agent to make medical decisions for you when you cannot — distinct from a financial POA.

Customise

Your full legal name (Principal)

Your date of birth

Your address

Governing state

Healthcare agent — full name

Healthcare agent — relationship

Healthcare agent — address

Healthcare agent — phone

Alternate agent — full name

Alternate agent — phone

When does the agent's authority begin?

Powers expressly granted (one per line)

Powers expressly DENIED (optional)

Special instructions for your agent

Signing date

City of signing

Live preview

HEALTHCARE POWER OF ATTORNEY

OF

JORDAN ALEX TAYLOR

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I, Jordan Alex Taylor (DOB June 12, 1985), of 482 Elm Street, Apt 3B, Portland, OR 97214, being of sound mind, hereby appoint the following person as my agent for healthcare decisions ("Healthcare Agent").

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ARTICLE I — APPOINTMENT

PRIMARY HEALTHCARE AGENT
Name:           Sam Taylor (Sister)
Address:        88 Pine Lane, Portland, OR 97214
Phone:          +1 503 555 0142

ALTERNATE HEALTHCARE AGENT (acts only if Primary cannot or will not serve)
Name:           Casey Brooks
Phone:          +1 503 555 0177

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ARTICLE II — WHEN THIS POWER TAKES EFFECT

Only when I am unable to make my own healthcare decisions.

A determination that I am unable to make my own healthcare decisions shall be made by my attending physician, or by such other procedure as state law requires.

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ARTICLE III — POWERS GRANTED

My Healthcare Agent has authority to make any healthcare decision I would otherwise be entitled to make, including:

Consent to or refuse any medical, surgical, hospital, or palliative treatment.
Access my medical records and discuss my care with all providers (HIPAA authority).
Choose, hire, or change healthcare providers and facilities.
Authorise hospice or palliative care.
Make decisions about life-sustaining treatment consistent with my advance directive.
Make organ-donation decisions consistent with my stated wishes.
Authorise mental-health treatment to the extent permitted by state law.

My Healthcare Agent shall consult with my treating physicians and follow my known wishes, including any advance directive I have signed.

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ARTICLE IV — POWERS EXPRESSLY DENIED

The following powers are NOT granted to my Healthcare Agent:

My agent may NOT consent to involuntary commitment beyond what is permitted by state law without separate court authorisation.
My agent may NOT consent to abortion if I am pregnant, except where necessary to save my life.
My agent may NOT consent to sterilisation, electroconvulsive therapy, or psychosurgery without specific written consent from me.

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ARTICLE V — SPECIAL INSTRUCTIONS

My agent should consult with my spouse and adult children where time permits, but my agent has final decision authority. My agent should give weight to quality of life over length of life when these conflict, consistent with my Advance Directive on file.

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ARTICLE VI — HIPAA AUTHORISATION

My Healthcare Agent is authorised to receive any of my protected health information (PHI) under the Health Insurance Portability and Accountability Act of 1996 (HIPAA), 45 CFR §§160-164, that the Agent reasonably needs to make decisions on my behalf. This authorisation has no expiration date during my lifetime and applies to all healthcare providers, health plans, and healthcare clearinghouses involved in my care.

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ARTICLE VII — RELIANCE BY THIRD PARTIES

A copy of this Document has the same effect as the original. Any healthcare provider or health plan that acts in good faith and without knowledge of revocation in reliance on this Document is protected from liability.

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ARTICLE VIII — REVOCATION

I may revoke this Document at any time, in any manner that communicates my intent to revoke, regardless of my mental or physical condition. This Document is automatically revoked upon my divorce from a spouse named as Agent, unless I expressly state otherwise.

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ARTICLE IX — GOVERNING LAW

This Document is governed by the laws of the State of Oregon.

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EXECUTION

Signed at Portland, Oregon, on this May 4, 2026.


_______________________________
Jordan Alex Taylor (Principal)


WITNESS ATTESTATION

We, the undersigned, declare that the Principal signed this Document in our presence, that the Principal appeared to be of sound mind and acting voluntarily, and that we are at least eighteen (18) years of age, are not named as Agent or Alternate, are not the Principal's attending physician, and are not entitled to any portion of the Principal's estate under any will or operation of law.


_______________________________            _______________________________
Witness 1 — printed name                    Witness 1 — signature & date


_______________________________            _______________________________
Witness 2 — printed name                    Witness 2 — signature & date


NOTARY ACKNOWLEDGEMENT (recommended; required in many states)

State of Oregon     )
                                          ) ss.
County of __________________              )

On May 4, 2026, before me personally appeared Jordan Alex Taylor, who proved to me on the basis of satisfactory evidence to be the person whose name is subscribed to this Document, and acknowledged executing it freely and voluntarily.

________________________________
Notary Public — signature & seal

My commission expires: ____________________


ACCEPTANCE BY HEALTHCARE AGENT (recommended)

I, Sam Taylor, accept appointment as Healthcare Agent. I understand that I owe a fiduciary duty to make decisions in the Principal's best interest, consistent with the Principal's known wishes and any advance directive.


_______________________________            Date: ____________________
Sam Taylor (Agent)

About this template

A healthcare power of attorney is the medical-decision counterpart to a financial POA, and the two should always be paired in a complete estate plan. Where the financial POA covers money and property, the healthcare POA covers consent to and refusal of medical treatment when you cannot speak for yourself. Many states recognise a single combined "advance directive" that includes both treatment preferences (the living-will portion) and the agent appointment (the healthcare-POA portion); other states keep the two as separate documents. This template is the agent-appointment portion. The Principal's most important choice is who to name. The agent must be willing to follow your wishes even if they personally disagree, must be reachable in an emergency (geographically close enough), and must understand your values well enough to handle situations the document does not anticipate. Many people default to a spouse, but think carefully about what happens if the spouse is also injured in the same event — name a non-spousal alternate. Healthcare agents acting alone (without an advance directive) face the harder job of inferring your wishes from scratch; pair the appointment with a separate advance directive that documents preferences for terminal conditions, persistent unconscious states, artificial nutrition, and pain management. Discuss the documents with the agent, the alternate, your primary physician, and your closest family before they are needed. Lodge copies with each. Re-execute every few years; some hospitals are reluctant to honour very old documents even where state law makes them durable.

When to use it

Every adult should have one — incapacity can happen at any age.
Before a planned hospitalisation or major surgery.
Diagnosis of a progressive condition (dementia, ALS, Parkinson's).
Major life event — marriage, divorce, child reaches adulthood, death of original agent.
Move to a new state — re-execute under the new state's form.

What to include

Principal and primary / alternate agent identification.
Trigger for when authority begins.
Specific powers granted (and explicitly denied).
HIPAA authorisation clause.
Witness attestation and notary acknowledgement.
Optional: Agent acceptance signature.

Frequently asked

A living will (advance directive) states YOUR preferences for end-of-life treatment. A healthcare POA appoints a PERSON to make decisions for you when you cannot. They work together — the agent should follow the directive when it covers the situation, and use judgment guided by your values when it does not. Most states allow combining both into a single document.

⚠ Legal disclaimer. Healthcare POA law is heavily state-specific. Most states have an official statutory form (often free at the Department of Health or Bar Association) that hospitals and providers accept more readily than custom forms. Witness and notary requirements vary by state — failing those formalities can render the document unenforceable at the moment it is most needed. Consult an estate-planning or elder-law attorney before signing, and pair this document with a separate Advance Directive (living will).