Health Care Power of Attorney - North Carolina

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North Carolina · Fillable PDF · Free

This is North Carolina’s official statutory form for naming a health care agent to make medical decisions for you when you cannot make or communicate them. This is North Carolina’s official statutory form for naming a health care agent to make medical decisions for you when you cannot make or communicate them.

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Who this form is for

This is North Carolina’s official statutory form for naming a health care agent to make medical decisions for you when you cannot make or communicate them.

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

Name your agents (Page 2) Name up to three agents, who serve one at a time in the order named, and optionally the physicians who determine incapacity.
Initial any limits and organ donation (Pages 4–6) Initial only the choices you want. No organ donation authority is granted without your initials.
Sign with two witnesses AND a notary (Pages 8–9) North Carolina requires your signature to be witnessed by two qualified witnesses and proved before a notary, all at the same time. We can provide qualified witnesses for an additional fee.
Give copies to your health care agents and doctors.
Consider filing it with the North Carolina Secretary of State’s Advance Health Care Directive Registry; registry filings must be notarized.

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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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