Health Care Power of Attorney - Pennsylvania

Pennsylvania · Fillable PDF · Free

This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself, and gives your agent access to your medical records. It does not cover money or property; for that, use a Durable General Power of Attorney. you need to name a health care agent to make medical decisions for you if you cannot make or communicate them yourself, and gives your agent access to your medical records.

Serving Pennsylvania. Appointments require a Pennsylvania-commissioned notary.

Download Health Care Power of Attorney - Pennsylvania PDF · 4 pages. No account required.

Book a notary for Health Care Power of Attorney - Pennsylvania

Who this form is for

  • This form lets you name a health care agent to make medical decisions for you if you cannot make or communicate them yourself, and gives your agent access to your medical records. It does not cover money or property; for that, use a Durable General Power of Attorney.

What you'll need

  • The original Health Care Power of Attorney - Pennsylvania packet and its instructions.
  • The names, dates and supporting records identified in this packet.
  • Acceptable identification if a notarial act is requested; arrange any required qualified witnesses.

How to complete it

  1. Choose when your agent may act Usually only when your doctor finds you cannot decide for yourself. You may allow it sooner.
  2. Initial the powers you grant Write your initials next to each power. A power you do not initial is not granted.
  3. Name your agent and alternates Your doctor or health care provider cannot be your agent unless related to you.
  4. Add guidance (optional) Describe your goals and values so your agent can follow them.
  5. Sign before two adult witnesses and a notary Do not sign ahead of time. Bring a current photo ID.

Related Pennsylvania forms

Pennsylvania · Fillable PDF · 6 pages · Free

Mental Health Advance Directive - Pennsylvania

This form lets you state your mental health treatment preferences in advance (the declaration) and name an agent to make mental health care decisions you have not covered (the power of attorney), in case a mental health crisis leaves you unable to decide. It lasts two years unless you are incapable when it would expire.

View Mental Health Advance Directive - Pennsylvania · Download Mental Health Advance Directive - Pennsylvania

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.

Free legal forms by state · Book a mobile notary