Patient Advocate Designation - Michigan

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In Michigan, a Patient Advocate Designation (Michigan’s health care power of attorney) names someone to make medical and mental health decisions for you when you cannot participate in them, and records your wishes. In Michigan, a Patient Advocate Designation (Michigan’s health care power of attorney) names someone to make medical and mental health decisions for you when you cannot participate in them, and records your wishes.

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Who this form is for

• In Michigan, a Patient Advocate Designation (Michigan’s health care power of attorney) names someone to make medical and mental health decisions for you when you cannot participate in them, and records your wishes.

What you'll need

• Read the packet and check the receiving agency's required form.
• Gather the names, dates and supporting records requested in the document.
• Review the packet's signing, identification and witness instructions.

How to complete it

1. Name your advocates (Page 1) Name a patient advocate and a successor.
2. Initial your choices (Page 2) An advocate may withhold or withdraw treatment that would allow you to die only if you say so clearly, which is why Section 3 is initialed.
3. Sign before two qualified witnesses (Pages 3–4) Michigan requires two witnesses, who may not be your spouse, parent, child, grandchild, sibling, heir, doctor, patient advocate, or an employee of your insurer, care facility, or mental health provider. We can provide qualified witnesses, and can also notarize it.
4. Advocate signs the acceptance (Page 5) Your advocate must sign the statutory acceptance before acting.
5. Give copies to your patient advocates, doctors, and hospital; it must be part of your medical record before it is used.

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