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Power of Attorney for Health Care - Illinois

Illinois · Fillable PDF · Free

This is Illinois’s official statutory form for naming someone (your “health care agent”) to make medical decisions for you if you cannot. It does not cover finances. This is Illinois’s official statutory form for naming someone (your “health care agent”) to make medical decisions for you if you cannot.

Download Power of Attorney for Health Care - Illinois PDF · 10 pages. No account required.

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Who this form is for

Illinois residents and families reviewing power of attorney for health care instructions.

What you'll need

Read the original packet’s instructions and complete only the fields that apply.
Bring acceptable identification and follow the packet’s signature and witness instructions.

How to complete it

Read the Notice (Pages 1–5) Illinois requires the Notice to come first, in large type. It explains how to choose an agent and what your agent can do.
Name your agent and successors (Page 6) Enter your name and address and your agent’s name, address, and phone number. You may name two successor agents.
Make your choices (Pages 7–8) Check one box for when your agent may act. Optionally check one life-sustaining treatment statement, and write any limits.
Delayed revocation (Page 8) Optionally check whether a revocation takes effect immediately or after 30 days.
Sign with a witness, then a notary (Page 9) Illinois requires one adult witness who is not your agent, a relative, or your health care provider. We also recommend notarizing it: hospitals, banks, and other states are more likely to accept a notarized directive. We can provide a qualified witness for an additional fee.

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Revocation of Health Care Power of Attorney - Illinois

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These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

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