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Legal Washington Medical Power of Attorney Form

The Washington Medical Power of Attorney form is a legal document that allows individuals to designate someone they trust to make medical decisions on their behalf in the event they become incapacitated. This form ensures that your healthcare preferences are honored when you are unable to communicate them yourself. Understanding and completing this form is crucial for anyone wishing to maintain control over their medical care, so take the first step by filling it out through the button below.

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Legal Washington Medical Power of Attorney Form

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In Washington State, the Medical Power of Attorney form is a vital document that empowers individuals to make healthcare decisions on behalf of another person when they are unable to do so themselves. This form allows you to designate a trusted person, often referred to as an agent or surrogate, to make medical choices based on your preferences and values. It's important to understand that the authority granted through this document can cover a wide range of medical decisions, from routine care to critical treatment options. Additionally, the form ensures that your healthcare wishes are respected, even if you cannot communicate them directly. Completing the Medical Power of Attorney form involves specifying your chosen agent, outlining any specific instructions you may have, and signing the document in accordance with state requirements. By preparing this form, you can provide peace of mind for both yourself and your loved ones, knowing that your healthcare decisions will be handled by someone you trust in times of need.

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Washington Medical Power of Attorney

This document grants the authority to an appointed individual (the "Agent") to make health care decisions on behalf of the signer (the "Principal") when the Principal is unable to make such decisions for themselves. This authority is recognized under the Washington Uniform Power of Attorney Act and specific provisions regarding healthcare decisions outlined therein.

Principal's Information:

Full Name: _______________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Date of Birth: ____________________________________________
Phone Number: ____________________________________________

Agent's Information:

Full Name: _______________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Relationship to Principal: _________________________________
Phone Number: ____________________________________________

Alternate Agent's Information: (Optional)

Full Name: _______________________________________________
Address: _________________________________________________
City, State, Zip: __________________________________________
Relationship to Principal: _________________________________
Phone Number: ____________________________________________

This Power of Attorney shall become effective upon the incapacitation of the Principal and will remain in effect until the Principal is again able to make their own medical decisions.

Authority Granted: The Agent is authorized to make any and all health care decisions on behalf of the Principal that the Principal could make if capable, including but not limited to:

Consent, refuse, or withdraw consent to any medical care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition.
Select or discharge health care providers and institutions.
Approve or disapprove diagnostic tests, surgical procedures, and programs of medication.
Direct the provision, withholding, or withdrawal of artificial nutrition and hydration and all other forms of health care, including cardiopulmonary resuscitation.
Access medical records.
Make decisions about organ donation, autopsy, and disposition of the body.

This designation shall not be affected by the Principal's subsequent incapacity.

Signatures:

This document must be signed by the Principal, the designated Agent, and the Alternate Agent (if applicable), in the presence of two adult witnesses or a notary public. The witnesses cannot be the Agent, the Principal's health care provider, or an employee of the health care provider. Witnesses must certify that the Principal appears to be of sound mind and not under duress, fraud, or undue influence.

Principal's Signature: _________________________________________ Date: ________________

Agent's Signature: _____________________________________________ Date: ________________

Alternate Agent's Signature (if applicable): ________________________ Date: ________________

Witness 1 Signature: __________________________________________ Date: ________________

Witness 2 Signature: __________________________________________ Date: ________________

Notary Public (if applicable): __________________________________ Date: ________________

This document is intended to be a durable power of attorney for health care as defined under Washington state law.

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PDF Data

Fact Name	Description
Purpose	The Washington Medical Power of Attorney form allows you to designate someone to make healthcare decisions on your behalf if you become unable to do so.
Governing Law	This form is governed by Washington State law, specifically RCW 11.94, which outlines the rules for advance directives.
Agent Authority	Your chosen agent can make decisions about medical treatments, including life-sustaining measures, based on your preferences.
Signature Requirements	The form must be signed by you and two witnesses or a notary public to be valid in Washington State.
Revocation	You can revoke the Medical Power of Attorney at any time, as long as you are of sound mind. This can be done verbally or in writing.
Durability	This power of attorney remains effective even if you become incapacitated, ensuring your agent can act when needed.
Additional Documents	It’s often recommended to pair the Medical Power of Attorney with a Living Will to provide clear guidance on your healthcare preferences.

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