Fillable Medical Power of Attorney Document for Missouri State

The Missouri Medical Power of Attorney form is a legal document that allows a person to appoint someone else to make healthcare decisions on their behalf, should they become unable to do so themselves. This form is an essential part of planning for the future, ensuring that one's health care wishes are respected and executed by a trusted individual. Don't wait until it's too late; secure your peace of mind by filling out the form today by clicking the button below.

Get Form Here

When facing the uncertainty of medical conditions, individuals often find reassurance in knowing that their healthcare decisions will remain in trusted hands should they become unable to make those decisions for themselves. The Missouri Medical Power of Attorney form is a vital legal document that enables Missouri residents to appoint someone they trust, commonly referred to as an 'agent', to make healthcare decisions on their behalf if they ever lose the ability to do so. This form covers a wide array of decisions, from routine medical treatments to more serious matters like life-sustaining procedures. It's designed with the individual's best interests in mind, ensuring that their health care preferences are respected and adhered to, even in their absence. The process of creating a Medical Power of Attorney is straightforward yet carries profound significance, providing peace of mind for both the person creating the document and their loved ones. By thoroughly understanding its major aspects, Missouri residents can ensure they are well-prepared for any future healthcare uncertainties.

Contents

Missouri Medical Power of Attorney Example

Missouri Medical Power of Attorney

This Missouri Medical Power of Attorney is a legal document that allows an individual (referred to as the Principal) to designate another person (referred to as the Agent) to make health care decisions on their behalf in the event they are unable to do so. This document is in compliance with the Missouri Durable Power of Attorney for Health Care Act.

Principal Information

Full Name: ________________________________

Date of Birth: _____________________________

Address: __________________________________

City: _____________________________________

State: Missouri

Zip Code: ________________________________

Agent Information

Full Name: ________________________________

Relationship to Principal: __________________

Primary Phone: ____________________________

Alternative Phone: ________________________

Email Address: _____________________________

Alternate Agent Information (Optional)

If the initial Agent is unable, unwilling, or unavailable to act as your agent, an alternate agent may act in their place.

Full Name: ________________________________

Relationship to Principal: __________________

Primary Phone: ____________________________

Alternative Phone: ________________________

Email Address: _____________________________

Authority of the Agent

The Agent is authorized to make all health care decisions for the Principal in accordance with the Principal’s wishes, including, but not limited to:

The power to consent, refuse, or withdraw consent to any and all types of medical care, treatment, surgical procedures, or diagnostic procedures.
The power to access medical records.
The power to decide on the Principal’s admission to or discharge from any hospital, nursing home, or other medical care facility.
The power to request, receive, and review any information regarding the Principal’s physical or psychological health, including medical and hospital records.
The power to apply for public benefits, such as Medicare and Medicaid, on behalf of the Principal.

Special Instructions

Here, the Principal can address limitations on the Agent’s authority or specify desired medical treatments under certain circumstances.

____________________________________________

Signature of Principal

Signature: ________________________________

Date: _____________________________________

Witness Affidavit

State of Missouri requires that this document be signed in the presence of two witnesses who meet specific legal criteria. The witnesses affirm that the Principal is of sound mind and under no duress or undue influence at the time of signing.

Witness 1

Full Name: ________________________________

Signature: ________________________________

Date: _____________________________________

Witness 2

Full Name: ________________________________

Signature: ________________________________

Date: _____________________________________

⇓ PDF File

Form Overview

Fact	Detail
Definition	A Missouri Medical Power of Attorney is a legal document that allows individuals to designate another person to make healthcare decisions on their behalf should they become unable to do so themselves.
Governing Law	Missouri's Durable Power of Attorney for Health Care Act, Sections 404.800 to 404.865 of the Missouri Revised Statutes, governs the creation and use of Medical Power of Attorney forms in Missouri.
Agent Qualification	The person appointed as an agent must be an adult and should not be the healthcare provider or an employee of the healthcare provider, unless they are related to the principal by blood, marriage, or adoption.
Witness Requirement	The Medical Power of Attorney must be signed in the presence of two or more qualified witnesses or a notary public as per Missouri law.
Limits of Authority	The agent's authority can include making decisions about medical care, treatment options, access to medical records, and the power to consent or refuse medical treatment, but cannot authorize euthanasia, mercy killing, or anything illegal under Missouri law.
Revocation	The principal can revoke the Medical Power of Attorney at any time, as long as they are of sound mind, through a signed and dated written document, by physically destroying the document, or by verbally expressing the intent to revoke in the presence of a witness.
Activation	The document generally becomes active when the principal is determined to be unable to make their own healthcare decisions by a healthcare provider.
Validity Across States	While Missouri recognizes Medical Power of Attorney documents made in other states if they comply with Missouri law, the document's validity in other states depends on the laws of those states concerning out-of-state Medical Powers of Attorney.

Documents used along the form

When preparing for future medical care, particularly in Missouri, a Medical Power of Attorney form is an essential legal instrument. It empowers a designated agent to make healthcare decisions on behalf of another person, should they become unable to do so themselves. However, to ensure comprehensive care planning, this document is often accompanied by a variety of other legal forms and documents. Each serves a specific purpose, contributing to a well-rounded healthcare directive and estate planning strategy. Below is a list of ten supplementary documents that individuals frequently use alongside a Missouri Medical Power of Attorney.

Advance Healthcare Directive: This document combines a living will and healthcare power of attorney, specifying an individual's healthcare preferences and appointing an agent to make healthcare decisions in situations not covered by the living will.
Living Will: Specifying one’s wishes regarding life-sustaining treatments, a living will comes into play if a person becomes terminally ill, incapacitated, or unable to communicate their healthcare preferences.
Do Not Resuscitate (DNR) Order: A medical order to forego resuscitation in case of cardiac or respiratory arrest. It must be signed by a physician and is used in addition to a living will.
Health Insurance Portability and Accountability Act (HIPAA) Release Form: This form permits healthcare providers to share an individual’s health information with designated others, ensuring the agent has access to necessary medical records to make informed decisions.
Durable Power of Attorney for Finances: Appoints an agent to manage an individual’s financial affairs, complementing the medical power of attorney by covering non-healthcare decisions.
Will and Testament: Specifies how an individual’s estate should be distributed upon their death, including the appointment of an executor to carry out their wishes.
Trust Documents: Used for estate planning, trusts manage an individual’s assets during and after their lifetime, often offering tax advantages and avoiding probate.
Declaration for Mental Health Treatment: Specifies preferences for psychiatric treatment and appoints an agent to make decisions on psychiatric interventions if an individual becomes incapable of making those decisions.
Organ and Tissue Donation Registration: A legal document to declare an individual’s intent to donate organs and tissues after death, which can be registered with the state’s donor registry.
Funeral Planning Declaration: Allows individuals to specify their wishes for funeral arrangements and appoints an agent to ensure these wishes are carried out, offering peace of mind to family members.

Together, these documents form a comprehensive legal framework that can address all aspects of a person’s care and estate in times of health crises or death. When considering a Medical Power of Attorney, it's wise to consult legal guidance to understand how these additional documents might complement your healthcare wishes and overall estate planning objectives. Each plays a vital role in ensuring an individual’s preferences are respected, assets are protected, and loved ones are provided for according to clearly expressed wishes.

Consider Some Other Medical Power of Attorney Templates for Specific States

How to Get Power of Attorney in Ct - It's important to choose an agent who is trustworthy, understands your wishes, and is willing to advocate on your behalf.

Power of Attorney Nh - In times of crisis, this document quickly informs health care providers about who has the legal right to make decisions on your behalf.

Medical Power of Attorney Florida - Helps to prevent confusion and disagreements among family members by clearly outlining who has the authority to make healthcare decisions.