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OTHER NAMES California Healthcare POA California Healthcare Power of Attorney California Medical POA California Healthcare Proxy

What is a California Medical Power of Attorney?

A California Medical Power of Attorney is a legal document that grants a selected person or entity the authority to make healthcare decisions for you, such as refusing or accepting medical treatment, when you cannot do so. 
 
The individual granting permission is called the "principal," while the person or entity obtaining authority is known as the "agent." Designed for residents of California, this Power of Attorney for health care is made for use in Los Angeles County, San Diego County, Orange County, and in every other part of the state. All California Healthcare PoA forms from Rocket Lawyer can be edited to address your specific circumstances. With this official legal document on hand, your agent(s) can offer proof to healthcare institutions and other parties that they can make choices for you.

When to use a California Medical Power of Attorney:

  • You trust someone to make healthcare decisions for you when you can't, and you want to make it legal.
  • Your health is declining and you want someone you trust to manage your medical care if needed.

Sample California Medical Power of Attorney

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POWER OF ATTORNEY FOR HEALTH CARE

 

. DESIGNATION OF AGENT. I designate the following individual as my agent to make health-care decisions for me:

 

Agent:

Name:

Address:

  ,

Phone: Home: Work:

 

 

 

. AGENT'S AUTHORITY. My agent is authorized to make all health-care decisions for me, including decisions to provide, withhold or withdraw artificial nutrition and hydration and all other forms of health care to keep me alive

 

. WHEN AGENT'S AUTHORITY BECOMES EFFECTIVE. My agent's authority becomes effective when my primary physician determines that I am unable to make my own health-care decisions

 

. AGENT'S OBLIGATION. My agent shall make health-care decisions for me in accordance with this Healthcare Power of Attorney and my other wishes to the extent known to my agent. To the extent my wishes are unknown, my agent shall make health-care decisions for me in accordance with what my agent determines to be in my best interest. In determining my best interest, my agent shall consider my personal values to the extent known to my agent.

 

. EFFECT OF COPY. A copy of this form has the same effect as the original.

 

. SIGNATURE.

 

Declarant Signature: _______________________________________

Name:

Address:

  ,

Date: _____________________

 

NOTICE: SPECIAL RULES APPLY IF YOU ARE A RESIDENT OF A SKILLED NURSING FACILITY. IF YOU RESIDE IN SUCH A FACILITY, THIS DOCUMENT MUST BE SIGNED BY A PATIENT ADVOCATE OR OMBUDSMAN. IF YOUR DOCUMENT IS BEING WITNESSED BY TWO WITNESSES, ONE OF THOSE WITNESSES MUST BE THE ADVOCATE OR OMBUDSMAN WHO SIGNS ALL WITNESS STATEMENTS. IF YOUR DOCUMENT IS BEING NOTARIZED, THE ADVOCATE OR OMBUDSMAN MUST SIGN THE SPECIAL WITNESS REQUIREMENT SECTION.

Name:

Address:

  ,

Name: ________________________________

Address: ________________________________

  ________________________________

  ________________________________

Name:

Address:

  ,

Name: ________________________________

Address: ________________________________

  ________________________________

  ________________________________

 

. SPECIAL WITNESS REQUIREMENT.

 

The following statement is required only if you are a patient in a skilled nursing facility - a health care facility that provides the following basic services: skilled nursing care and supportive care to patients whose primary need is for availability of skilled nursing care on an extended basis. The patient advocate or ombudsman must sign the following statement:

 

STATEMENT OF PATIENT ADVOCATE OR OMBUDSMAN: I declare under penalty of perjury under the laws of California that I am a patient advocate or ombudsman as designated by the State Department of Aging and that I am serving as a witness as required by Section 4675 of the Probate Code.

 

 

 

Witness Signature:  ________________________________________

 

Name: ______________________________

Address: ______________________________

City, State, Zip: ______________________________

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California Medical Power of Attorney FAQs

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  • How can I get Medical Power of Attorney in California?

    It is quick and easy to grant or obtain the authority you need with a free California Medical Power of Attorney template from Rocket Lawyer:

    1. Make the PoA - Answer a few questions and we will do the rest
    2. Send and share it - Look over it with your agent or ask a lawyer
    3. Sign and make it legal - Required or not, witnesses/notarization are recommended

    This solution is, in most cases, notably less expensive than hiring a conventional attorney. If necessary, you can start a Medical PoA on behalf of a family member, and then have that person sign it when ready. Please remember that for a Power of Attorney to be accepted as valid, the principal must be mentally competent at the time of signing. If the principal has already been declared legally incompetent, a conservatorship might be required. In this scenario, it is important to speak to a lawyer .

  • Who should have a Power of Attorney for healthcare in California?

    Anyone who is over 18 years old ought to have a Medical Power of Attorney. Even though it's painful to acknowledge, there will likely come a time when you are not able to make important decisions on your own. Here are some common situations where you may find power of attorney to be helpful:

    • You are getting older or dealing with ongoing health issues
    • You currently live in or have plans to move into an adult care facility
    • You are planning for an upcoming medical procedure or period of hospitalization
    • You have been given a terminal diagnosis

    Regardless of whether your California Medical Power of Attorney is being created in response to an urgent issue or as part of a forward-looking plan, notarization and/or witnesses are strongly encouraged for protecting your document if someone disputes its lawfulness.

  • Are a California Healthcare Proxy and a California Medical Power of Attorney the same thing?

    Sometimes, in researching the subjects of elder care and estate planning, you might see the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" being used interchangeably. In reality, they are the same. That being said, please keep in mind that it's entirely possible to have agency over affairs that are not related to health care. In that case, "proxy" usually is not the term of choice.

  • Do I need to work with a lawyer for my California Medical PoA?

    California Medical PoA forms are usually easy to make, but you or your agent(s) might still have questions. It can depend on whom you contact, but quite often some lawyers will not even accept requests to review documents that they did not write. An easier approach to consider is to go through attorney services at Rocket Lawyer. With a Premium membership, you will be able to request guidance from an experienced attorney or send other legal questions about your Medical Power of Attorney. We're here for you.

  • What might it normally cost to get a Power of Attorney form for health care in California?

    The fees associated with finding and working with the average lawyer to produce a Medical Power of Attorney could total between two hundred and five hundred dollars, based on your location. Unlike most other Power of Attorney template websites that you might encounter, Rocket Lawyer provides Premium members up to 40% in savings when hiring a lawyer, so an attorney can take action on your behalf if you ever need help.

  • Are there any additional steps that I should take once I have drafted a California Medical Power of Attorney?

    With a membership, you can edit it, download it as a Word or PDF file, and print it out. In order to complete your Power of Attorney, it will need to be signed. Your agent(s), care providers, and other impacted parties should receive a copy of your fully executed document.

  • Does a Medical Power of Attorney need to be notarized, witnessed, or recorded in California?

    The specific requirements and restrictions governing PoA forms will vary in each state; however, in California, your document must be signed by two witnesses or notarized. Witnesses to a Healthcare PoA should not be any employer or operator of the healthcare or community/residential care facility providing your care. Only one of the witnesses may be someone who is an heir, a beneficiary, or otherwise legally related to you (such as a spouse, adopted child, or family member). Finally, as a general principle, your witness(es) will need to be over 18 years old, and none of them should also be your Power of Attorney agent.

    See California Medical/Healthcare Power of Attorney law: § 4680 - 4691

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