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Medical power of attorney

A medical power of attorney names the person who can talk to doctors and make treatment decisions when you cannot. The person you name is often called a health care agent, proxy or surrogate. The document is sometimes called a health care proxy or a designation of health care surrogate, depending on the state.

It is different from a living will. A living will states what treatment you want, usually at the end of life. A medical power of attorney names a decision maker who can respond to situations you did not predict. Most people should have both, and many states combine them into a single advance directive.

Written by Nora Whitfield, editorial lead. State rules checked by Samuel Okafor, rules editor, on October 20, 2026.

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Filled sample, Colorado

Medical power of attorney

STATE OF COLORADO

I, Grace A. Whitfield, of 240 Juniper Way, Denver, CO 80206, appoint Samuel T. Whitfield, of 18 Aspen Court, Denver, CO 80209, phone 303-555-0142, as my health care agent. If my agent cannot or will not serve, I appoint Nadia R. Whitfield, phone 303-555-0177, as my alternate agent. This document is governed by the laws of the State of Colorado.

1. Authority of my agent

My agent may consent to, refuse or withdraw medical care, treatment, surgery, tests and medication for me; choose and discharge health care providers; authorize admission to or transfer from a hospital, nursing facility, assisted living facility or hospice; and take the steps needed to carry out my wishes. My agent may sign releases and waivers that a provider requires for treatment.

2. Health information and HIPAA

I authorize every physician, hospital, clinic, insurer, pharmacy and other health care provider to disclose my protected health information to my agent, and to discuss my condition and treatment with my agent. This authorization is intended to satisfy the HIPAA privacy rule and remains in effect while this document is in effect.

3. When this takes effect

This authority takes effect when my attending physician determines that I cannot make or communicate health care decisions for myself. It continues during any period of incapacity and ends when I regain the ability to make those decisions, unless a court or the law says otherwise.

4. Life-sustaining treatment

My instruction about life-sustaining treatment is: try for a limited time. If the choice is to try treatment for a limited time, my agent should stop treatment when my physicians agree that there is no reasonable chance of recovery. My agent should not interpret this instruction as a request to withhold comfort care.

5. Artificial nutrition and hydration

My instruction about feeding tubes and intravenous nutrition is: stop if recovery is not expected.

6. Pain relief and comfort

My instruction about pain relief is: comfort is the priority. I want my agent and my care team to treat pain and shortness of breath aggressively, even when comfort-focused treatment may shorten my life. I do not want to be left in pain because of a fear of addiction or of hastening death.

7. Organ and tissue donation

My choice about organ and tissue donation is: yes. If the choice is to donate, my agent may consent to the procedures and coordinate with the organ procurement organization.

8. My wishes

The following matters are important to me: I want to be cared for at home if that is possible. I do not want to be kept alive by a machine if there is no reasonable chance of recovery. I want my agent to be able to visit and to speak with my doctors..

Religious or cultural wishes: Please call my pastor, the Reverend Elena Marsh, if I am hospitalized for more than a few days..

9. Limits on my agent

My agent may not consent to psychosurgery, sterilization, abortion, admission to a mental health facility for long-term care, or any other treatment that state law excludes from a health care proxy, unless a court order authorizes it. My agent may not use this document for financial decisions.

10. Revocation

I revoke all earlier health care proxies and medical powers of attorney. I may revoke this document at any time by signing a written revocation, by telling my physician, or by signing a new document. A divorce or annulment may revoke the appointment of a former spouse under state law.

11. Copies and reliance

A photocopy or electronic copy of this signed document has the same effect as the original. A health care provider may rely on it in good faith. If any part is unenforceable, the rest remains in effect. The laws of the State of Colorado govern this document.

Principal

Principal

Signature

Printed name: Grace A. Whitfield

Date

Agent acceptance

Agent

Signature

Printed name: Samuel T. Whitfield

Date

Signing requirements: Colorado: A notary is not required. No witnesses are required. A medical durable power of attorney needs no witnesses or notary.

Source: Colo. Rev. Stat. §§ 15-18-101 to 15-18-113.

Generated from a PaperDeed template. PaperDeed is not a law firm and this is not legal advice. Template review date: October 20, 2026.

Example answers, not advice. The builder replaces them with yours.

Full sample below

Use this form when

  • Choosing a spouse, adult child or friend to make medical decisions if you cannot.
  • Making sure a hospital will speak to the person you trust, even before a crisis.
  • Adding instructions about life-sustaining treatment, pain relief and organ donation.
  • Replacing an old health care proxy after a move, a divorce or a change of mind.

Have this ready

  • The agent's full legal name, address and phone number, and an alternate agent.
  • A clear idea of what you want at the end of life, in your own words. You do not need legal phrasing.
  • The names of two adult witnesses who are not your agent and, in most states, not your heirs or health care providers.
  • Your state, because witness rules are stricter than they look and a hospital may refuse a form that misses one.

Build the medical power of attorney

The preview updates as you type. Your work is saved automatically.

This changes the signing block and the rule citations.

Step 1 of 2

You and your agent

Name someone who will be reachable, willing to ask hard questions, and able to follow your wishes rather than their own.

Download this medical power of attorney

PDF for printing and signing. DOCX so you can edit it in Word or Google Docs. This form is included for every state.

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What the form includes

Agent appointment

A primary agent and an alternate, with the authority to consent to or refuse treatment.

Scope of authority

Hospitals, doctors, records, discharge and end-of-life decisions, with the limits you set.

Your instructions

A plain-language statement of what matters to you, including pain relief and life-sustaining treatment.

HIPAA authorization

Permission for the agent to receive and discuss your protected health information.

Organ and tissue donation

A choice to donate, decline, or leave the decision to your agent.

Witness and notary block

The signing lines the state requires, with the statute or official form cited.

After you sign

Give copies to the people who need them

Give a copy to your agent, your alternate, your doctor and the hospital where you are most likely to be treated. Keep a photo on your phone and tell a family member where the original is.

Talk it through

The document starts a conversation. Tell your agent what you would want in the situations that worry you, and ask whether they are willing to carry it out. A signed form cannot answer every question in the room.

Update after a move or a change

A form signed in one state is often accepted in another, but the witness rules differ. If you move, make a new document in the new state and revoke the old one.

Pair it with a living will

The agent needs instructions, and the living will supplies them. Keep both documents together and make sure the people who may need them know they exist.

Signing rules for this form

The builder shows the rule for every state and adds the right signature block. These state guides go deeper on the four biggest searches.

CONo notaryRules cited

Colorado: A notary is not required. No witnesses are required. A medical durable power of attorney needs no witnesses or notary.

Colo. Rev. Stat. §§ 15-18-101 to 15-18-113 (opens the official source in a new tab)

Detailed state guides are not published for this form yet. The builder still applies the signing rule for all 50 states and DC, with a citation to the statute or state form for each one.

Rules reviewed October 20, 2026. Every rule names its statute or state form, and the citation links to the official text where the state publishes it online.

Questions people ask

What is the difference between a medical power of attorney and a living will?

A medical power of attorney names a person to make decisions. A living will states your wishes about treatment. The agent can respond to situations the living will did not anticipate, which is why the two work best together.

Does a medical power of attorney need to be notarized?

Some states require two witnesses and no notary. Some accept a notary instead of witnesses. A few require both. The builder shows the rule for your state, cites the statute and adds the correct lines.

Can my doctor be my agent?

Most states prohibit a treating health care provider from serving as agent or witness. Choose someone who is not on your care team, and check the state's rule if you are unsure.

Can my agent decide to stop treatment?

The document can authorize the agent to refuse or withdraw life-sustaining treatment, but the exact scope depends on state law and on what you wrote. Put your wishes in the instructions and talk to your agent about them.

Does a medical power of attorney expire?

Usually not. It lasts until you revoke it, until you die, or until a court removes the agent. Some states require a new form after a set number of years for certain facilities, so check with the hospital if yours is old.

Related documents and guides

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Living will (advance directive)

Write a living will that states your wishes for end-of-life treatment. State witness and notary rules cited. Preview free, then download PDF and DOCX.

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Durable power of attorney

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Power of attorney

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Guide

Living will vs advance directive

A living will records your treatment wishes. An advance directive is the umbrella term and often includes a health care proxy. Here is how the two fit.

Guide

Living will vs trust vs will

A living will covers medical care, a will covers property after death, and a trust holds property during life. How the three differ and fit.

Before you use this document

PaperDeed is not a law firm and does not provide legal advice. We provide self-help templates and general information about signing rules. If you are unsure whether a document fits your situation, talk to a licensed attorney in your state.

Every signing rule above names its statute or state form, and links to the official text where the state publishes it online. Rules updated October 20, 2026.

PaperDeed is a self-help service. Templates and state rules were reviewed on October 20, 2026. 5 background guides are available if you want the explanation behind the form.