Fillable Medical Power of Attorney Document for Wyoming State

The Wyoming Medical Power of Attorney form is a legal document that allows individuals to appoint someone they trust to make healthcare decisions on their behalf, should they become unable to do so. This critical form serves as a bridge, ensuring that personal health care preferences are honored, even in times when direct communication may not be possible. For those looking to safeguard their medical decisions, filling out this form is a proactive step towards peace of mind. Click the button below to begin the process of securing your healthcare future.

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When the unexpected occurs, having arrangements concerning one's healthcare preferences can offer peace of mind not just to individuals but also to their families. Among such arrangements, the Wyoming Medical Power of Attorney form plays a pivotal role. This legal document grants someone you trust, often called an agent, the authority to make health care decisions on your behalf should you become unable to do so. The power ranges from selecting doctors to making end-of-life choices, thereby encompassing a wide array of medical decisions. This form is not just about assigning responsibilities; it's about entrusting a loved one with your well-being and ensuring that your medical preferences are respected, regardless of the situation. Understanding the scope, limitations, and the process of appointing a healthcare agent through this document is crucial. It's designed to reflect the granular decisions related to one's health that might need to be made, making it an indispensable tool in healthcare planning and personal preparedness.

Contents

Wyoming Medical Power of Attorney Example

This Wyoming Medical Power of Attorney form allows you to appoint someone you trust to make health care decisions on your behalf if you are not able to do so. This document is guided by the Wyoming Health Care Decisions Act.

Principal Information (Person Granting Power):

Name: ___________________________
Address: _________________________
City: ____________________________
State: Wyoming
Zip Code: ________________________
Phone Number: ____________________

Agent Information (Person Granted Power):

Name: ___________________________
Relationship to Principal: _________
Address: _________________________
City: ____________________________
State: ___________________________
Zip Code: ________________________
Alternate Phone Number: ___________

In the event the primary agent is unable or unwilling to serve, an alternate agent may be named:

Alternate Agent Information:

Name: ___________________________
Relationship to Principal: _________
Address: _________________________
City: ____________________________
State: ___________________________
Zip Code: ________________________
Phone Number: ____________________

Authority Granted to Agent:

The agent is authorized to make all health care decisions on my behalf, including decisions about health care procedures to maintain, diagnose, or treat my physical or mental condition.
The agent's authority becomes effective when I am unable to communicate my health care decisions.
This Medical Power of Attorney does not authorize the agent to make end-of-life decisions. A separate directive is needed for those purposes.

Special Instructions:

_____________________________________________________________
_____________________________________________________________
_____________________________________________________________

Signature of Principal: _______________________________ Date: ________________

Signature of Agent: _________________________________ Date: ________________

This document was signed in the presence of two witnesses, not related to the principal by blood, marriage, or adoption, and not entitled to any part of the estate of the principal under a will or by operation of law.

Witness 1 Signature: __________________________________ Date: ________________

Witness 2 Signature: __________________________________ Date: ________________

Notarization (If required):

This document was acknowledged before me on (date) ______________ by (names of principal and agent) _________________________________________.

Name of Notary: _________________________

My Commission Expires: __________________

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Form Overview

Fact	Description
Definition	A Wyoming Medical Power of Attorney form is a legal document that allows an individual to appoint another person to make healthcare decisions on their behalf should they become unable to do so.
Essential Elements	The form must include the principal's name, the agent's name, specific powers granted, and signatures from the principal, agent, and a notary or witnesses, as required by Wyoming law.
Governing Laws	Wyoming Statutes Title 35 - Public Health and Safety; specifically, Chapter 22 - Health Care Decisions Act governs the use and requirements of the Medical Power of Attorney in Wyoming.
Agent's Authority	The appointed agent is granted the authority to make healthcare decisions on the principal’s behalf, which can include consent, refusal, or withdrawal of treatment, access to medical records, and decisions about organ donation, among others.
Limitations	An agent under a Medical Power of Attorney does not have the authority to make decisions regarding involuntary commitment or psychosurgery without specific authorization stated in the document.
Activation	The document becomes effective when the principal's attending physician certifies in writing that the principal lacks the ability to make or communicate healthcare decisions.
Revocation	The principal can revoke the power of attorney at any time, as long as they possess the mental capacity to do so, through a written notice, destruction of the document, or an oral statement to a healthcare provider.
Duration	Unless stated otherwise within the document, the Medical Power of Attorney remains effective until the principal’s death or until it is revoked.
Witness Requirements	Wyoming law requires the Medical Power of Attorney to be either signed in the presence of two or more adult witnesses or notarized. Witnesses should not be the appointed agent, related to the principal, or have a claim against the principal’s estate.

Documents used along the form

When individuals in Wyoming decide to set up a Medical Power of Attorney, it often involves more than just this single form. This document is a significant part of ensuring one’s health care wishes are honored, but it’s frequently accompanied by other legal documents to provide a more comprehensive approach to planning. Each of these documents plays a critical role in managing health care decisions and personal affairs.

Living Will: This document complements the Medical Power of Attorney by allowing individuals to specify their wishes regarding end-of-life care. It becomes active only if the person is incapacitated and facing a life-threatening condition, ensuring their preferences for treatment are followed.
Do Not Resuscitate (DNR) Order: A DNR is a medical order that tells health care professionals not to perform CPR if the patient’s breathing stops or if their heart stops beating. It is designed for people who want to avoid aggressive life-sustaining treatments.
HIPAA Release Form: The Health Insurance Portability and Accountability Act (HIPAA) protects a person’s privacy concerning their medical records and health information. A HIPAA Release Form allows specified individuals, such as those holding a Medical Power of Attorney, to access the person's medical records, facilitating informed medical decisions.
Will or Testament: While not directly related to medical decisions, a Will is an essential document that specifies how a person’s property and affairs should be handled after their death. It can work alongside medical directives to ensure a person’s overall wishes are respected.

Together with the Medical Power of Attorney, these documents form a complete framework for managing health care and personal matters. It’s important for individuals to consider all these components when planning for the future, ensuring that their wishes are understood and can be legally upheld.

Consider Some Other Medical Power of Attorney Templates for Specific States

Medical Power of Attorney Iowa - By designating a Medical Power of Attorney, you can specify your preferences for life-sustaining treatments, organ donation, and other critical care options.

Medical Power of Attorney Mn - With a Medical Power of Attorney, you can select a trusted person to make critical medical decisions on your behalf.