After you download and fill out this form, follow these steps:
- Carefully read and review the form. If leaving any sections blank, write “None” in that space or cross out the entire section.
- Cross out any items on page 4 that you don’t want your agent to be able to decide.
- Sign the form. You must either sign the form in front of two witness who fill out the witness statement on page 9, or sign the form in front of a notary public.
- Make copies. After the form is signed, make several photocopies.
- Share copies of the form. Give a copy of the form to your agent, your doctor and the hospital you are likely to be admitted to. Anytime you go to the hospital, bring a copy of the form with you.
- Talk with your loved ones. It is helpful to share that you have a durable healthcare power of attorney with your loved ones. That way, they know who your agent is in case of an emergency.