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Revocation of Health Care Power of Attorney - Illinois

Illinois · Fillable PDF · Free

Use this form to cancel an Illinois power of attorney for health care, a living will declaration, or both, so your doctors and former agents know the old document no longer applies. Use this form to cancel an Illinois power of attorney for health care, a living will declaration, or both, so your doctors and former agents know the old document no longer applies.

Download Revocation of Health Care Power of Attorney - Illinois PDF · 3 pages. No account required.

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Who this form is for

Illinois residents and families reviewing revocation of health care power of attorney 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

Identify the documents (Page 1) Check each document you are revoking and enter its date and the name of any agent named in it.
Sign and date (Page 1) Illinois lets you revoke these documents at any time. A signed and notarized revocation gives clear proof of the date and your identity if anyone later questions it. Bring a current, government-issued photo ID.
Notify your doctors and agents (Page 2) Give a copy to your doctor, hospital, and each agent named in the old document, and record each notice on Page 2.

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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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