Fillable Medical Power of Attorney Document for California State

The California Medical Power of Attorney form is a legal document that grants individuals the power to make healthcare decisions on behalf of someone else, should they become unable to do so themselves. This critical form ensures that decisions regarding medical treatment align with the principal's wishes, even when they can't communicate them. Ensure your healthcare wishes are honored by clicking the button below to fill out the form.

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When the time comes that a person can no longer make healthcare decisions for themselves, it's crucial to have a plan in place. This is where the California Medical Power of Attorney (MPOA) form becomes vital. It's a legal document that allows individuals to appoint someone they trust to make medical decisions on their behalf if they're incapacitated. Understanding this form is essential for everyone, as it covers decisions ranging from minor medical interventions to more significant, life-sustaining treatments. The appointed person, often called an agent, is given the authority to discuss the individual's wishes with healthcare providers and ensure they are followed, even if the individual can no longer communicate their desires. This process not only ensures that medical treatment aligns with the individual's wishes but also relieves family members from the burden of making difficult decisions during stressful times.

Contents

California Medical Power of Attorney Example

California Medical Power of Attorney

This Medical Power of Attorney is a legal document that grants an agent the authority to make healthcare decisions on behalf of the principal, in accordance with the California Probate Code sections 4600-4806 related to durable powers of attorney for health care. By completing and signing this document, the principal ensures that their healthcare wishes are known and considered, even when they are unable to communicate them directly.

Principal Information

Full Name: __________________________________________________
Address: ____________________________________________________
City, State, Zip: ___________, California, ___________________
Date of Birth: ______________________________________________
Social Security Number: ______________________________________

Agent Information

Full Name: __________________________________________________
Relationship to Principal: ___________________________________
Primary Phone: ______________________________________________
Alternate Phone: ____________________________________________
Email Address: ______________________________________________

Alternate Agent Information (Optional)

Full Name: __________________________________________________
Relationship to Principal: ___________________________________
Primary Phone: ______________________________________________
Alternate Phone: ____________________________________________
Email Address: ______________________________________________

In the event the primary agent is unable, unwilling, or unavailable to serve, the alternate agent will assume the powers granted under this document.

Special Instructions

Here, the principal may include any specific wishes, limitations, or special instructions for healthcare decisions. Such instructions might involve preferences about artificial life support, surgical procedures, organ donation, and other important considerations.

Duration

This Medical Power of Attorney shall become effective on the date signed by the principal and shall remain in effect until it is revoked. To revoke, the principal must either communicate the decision to revoke directly to the agent or in writing.

Signature

By signing below, I affirm that I understand the nature and purpose of this document, the powers granted to my agent, and that I am signing this document voluntarily.

Principal's Signature: ____________________________________ Date: _____________
Agent's Signature: ______________________________________ Date: _____________
Alternate Agent's Signature (if applicable): ________________ Date: _____________

Witnesses (Optional in California, but recommended)

Under the California Probate Code, it is not required but recommended that this document be signed by at least two witnesses who are present when the principal signs or acknowledges the principal's signature. Neither agent appointed in this document nor the healthcare provider, nor any operator or employee of a healthcare facility where the principal is receiving care, can act as a witness.

Witness 1 Signature: ____________________________________ Date: _____________
Witness 2 Signature: ____________________________________ Date: _____________

This template is provided as a guide and does not constitute legal advice. Individuals are advised to seek professional legal advice for their particular situation.

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Form Overview

Fact Number	Fact Detail
1	The California Medical Power of Attorney is officially referred to as an Advance Health Care Directive.
2	It allows a person to appoint an agent to make health care decisions on their behalf if they become unable to do so.
3	The form can include preferences for specific types of health care treatments and end-of-life decisions.
4	Under California law, the form does not require notarization but must be signed by two witnesses.
5	One of the witnesses must be someone other than a relative, heir, or medical provider to ensure impartiality.
6	The agent appointed cannot act as a witness to the signing of the document.
7	California Probate Code Sections 4600-4805 cover the legal aspects and requirements of the Advance Health Care Directive.
8	It's recommended to discuss your health care wishes with the chosen agent before completing the form.
9	The document can be revoked or replaced at any time by the individual as long as they are competent.

Documents used along the form

When preparing for medical decisions, several forms can complement the California Medical Power of Attorney (MPOA). These documents collectively ensure that a person's healthcare wishes are comprehensively documented, making it clearer for healthcare providers and loved ones to adhere to those wishes. Each form serves a specific purpose but works in concert with the MPOA to create a thorough plan for various situations.

Advance Health Care Directive (AHCD): This document combines a living will and a medical power of attorney, allowing individuals to outline their healthcare preferences and appoint an agent to make decisions on their behalf if they are unable to do so. In California, the AHCD often includes the MPOA, making it a pivotal component of healthcare planning.
Physician Orders for Life-Sustaining Treatment (POLST): Often used in conjunction with the MPOA, the POLST form specifies the types of medical treatment that a patient wishes to receive towards the end of their life. It is filled out by the patient and their doctor, ensuring that the patient's wishes about life-sustaining treatments are clearly documented and immediately actionable by healthcare providers.
Do Not Resuscitate (DNR) Order: This form is a doctor's order that instructs healthcare providers not to perform cardiopulmonary resuscitation (CPR) if a patient's breathing stops or if the patient’s heart stops beating. It is intended for individuals who wish to avoid aggressive measures to prolong life in the event of cardiac or respiratory arrest.
HIPAA Authorization Form: This form allows healthcare providers to share a patient’s health information with designated individuals, such as family members or the agent named in an MPOA. It is crucial for ensuring that a patient’s health information can be shared in accordance with their wishes, particularly when discussing conditions and treatments with those who may be making decisions on their behalf.
Living Will: Although part of the AHCD in California, a living will can also stand alone in other contexts. It allows individuals to state their wishes regarding the withdrawal or withholding of life-sustaining treatment if they become terminally ill or permanently unconscious. A living will can supplement an MPOA by providing detailed instructions on end-of-life care preferences.

Collectively, these documents provide a comprehensive framework for managing healthcare decisions and end-of-life care. Each serves to clarify the individual's wishes, ensuring their autonomy and reducing the burden on loved ones during challenging times. It is advisable for individuals to discuss these forms with a healthcare professional and a legal advisor to ensure they fully understand and accurately express their healthcare wishes.

Consider Some Other Medical Power of Attorney Templates for Specific States

Power of Attorney Utah - Eliminate the guesswork for your loved ones during difficult times by appointing a healthcare agent in a Medical Power of Attorney.

North Dakota Power of Attorney Form - A Medical Power of Attorney closes the gap in healthcare planning, covering decisions that a living will may not address.

What Is Power of Attorney in a Will - This document is crucial for planning ahead and maintaining control over your medical care in case of unexpected situations.