Create Your Document In Just 3 Easy Steps:
Answer a few simple questions to make your document in minutes
Start now and save your progress, finish on any device
Store securely, share online and make copies
This document has been customized over 19.5K times
Legally binding and enforceable
Ask a lawyer questions about your document
MEDICAL DURABLE POWER OF ATTORNEY
. DESIGNATION OF HEALTH CARE AGENT. I, , of , , appoint
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
| Relation, if any: |
as my Agent to make health care and personal decisions for me if I become unable to make such decisions for myself, except to the extent I state otherwise in this document.
NOTICE: Generally you should not appoint any of the following persons as your Agent:
1. your treating physician or health care provider;
2. an employee of your physician or health care provider unless the person is your relative;
3. your residential care provider; or
4. an employee of your residential care provider unless the person is your relative.
The term "health care" as used in this document includes all medical treatment, the provision, withholding or withdrawal of any health care medical procedure, including surgery, cardiopulmonary resuscitation, or service to maintain, diagnose, treat or provide for a patient's physical or mental health or personal care, unless such authority is otherwise limited by this document.
. CREATION OF MEDICAL DURABLE POWER OF ATTORNEY. By this document I intend to create a Durable Power of Attorney. This Durable Power of Attorney shall take effect upon my disability, incapacity, or incompetency, and shall continue during such disability, incapacity, or incompetency.
. GENERAL STATEMENT OF AUTHORITY GRANTED. Subject to any limitations in this document, I grant to my Agent full power and authority to make health care decisions for me to the same extent that I could make such decisions for myself if I had the capacity to do so. My Agent authority to direct the withdrawal and withholding of artificially provided food and fluids. In making any decision, my Agent shall attempt to discuss the proposed decision with me to determine my desires if I am able to communicate in any way.
In exercising this authority, my Agent shall make health care decisions that are consistent with my desires as stated in this document or otherwise made known to my Agent. If my desires regarding a particular health care decision are not known to my Agent, then my Agent shall make the decision for me based upon what my Agent believes to be in my best interests.
. AUTOPSY, ANATOMICAL GIFTS, DISPOSITION OF REMAINS. I to make anatomical gifts of part or all of my body for medical purposes, authorize an autopsy, and direct the disposition of my remains.
I hereby make an anatomical gift, to be effective upon my death, of
I hereby make an anatomical gift, to be effective upon my death, of
SECOND ALTERNATE AGENT
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
. NOMINATION OF GUARDIAN. If a Guardian of my person is to be appointed for me, I nominate my Agent (or Alternate Agent) to serve as my Guardian.
. NOMINATION OF GUARDIAN. If a Guardian of my person is to be appointed for me, I nominate
| Name: |
| Address: |
| , |
to serve as my Guardian.
. GENERAL PROVISIONS
1. HOLD HARMLESS. All persons or entities who in good faith endeavor to carry out the terms and provisions of this document shall not be liable to me, my estate, my heirs or assigns for any damages or claims arising because of their action or inaction based on this document, and my estate shall defend and indemnify them.
2. SEVERABILITY. If any provision of this document is held to be invalid, such invalidity shall not affect the other provisions which can be given effect without the invalid provision, and to this end the directions in this document are severable.
3. STATEMENT OF INTENTIONS. It is my intent that this document be legally binding and effective. If the law does not recognize this document as legally binding and effective, it is my intent that this document be taken as a formal statement of my desire concerning the method by which any health care decisions should be made on my behalf during any period in which I am unable to make such decisions.
(YOU MUST DATE AND SIGN THIS DOCUMENT)
(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY)
I have read and understand the contents of this document and the effect of this grant of powers to my Agent. I am emotionally and mentally competent to make this declaration.
Signed on _____ day of _______________, _____.
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
STATEMENT OF WITNESSES
I declare that the person who signed or acknowledged this document () is personally known to me, that signed or acknowledged this document in my presence, that the appears to be of sound mind, and under no duress, fraud or undue influence. I am not the person appointed as Agent or Alternate Agent by this document, nor am I a provider of health or residential care, an employee of a provider of health or residential care, the operator of a community care facility, or an employee of an operator of a health care facility.
I further declare that I am not related to by blood, marriage, or adoption, and to the best of my knowledge, I am not a creditor of or entitled to any part of the estate of under a will now existing or by operation of law. I do not presently have a claim against the estate of at the death of . If is a patient or resident of a health care facility, I am not a patient of that facility.
| Witness Signature: | ________________________________________ |
Date: ______________________________
| Witness Signature: | _________________________________________ |
Date: ______________________________
State of _________________________,
County of _________________________ ss:
On this _____ day of _______________, _____, , known to me (or satisfactorily proven) to be the person named in the foregoing instrument, personally appeared before me, a Notary Public, within and for the said State and County, and acknowledged that he/she freely and voluntarily executed the same for the purposes stated in the document.
My commission expires: _____________________
_____________________________________
Notary Public
All the legal documents you need—customize, share, print & more
Unlimited electronic signatures with RocketSign®
Ask a lawyer questions or have them review your document
Dispute protection on all your contracts with Document Defense®
30-minute phone call with a lawyer about any new issue
Discounts! Incorporate for FREE + hire a lawyer with up to 40% off*
*Free incorporation for new members only and excludes state fees. Lawyer must be part of our nationwide network to receive discount.
It is very easy to grant or receive the authority you might need using a free Colorado Medical Power of Attorney template from Rocket Lawyer:
This solution, in many cases, will end up being much more affordable than finding and hiring your average law firm. If needed, you can start this Medical PoA on behalf of your spouse, an elderly parent, or another relative, and then help that person sign once you've drafted it. Please remember that for a Power of Attorney to be accepted as valid, the principal must be mentally competent when they sign. If the principal is already unable to make their own decisions, a court-appointed conservatorship may be necessary. When facing this situation, it is important to talk to an attorney .
Anyone who is over 18 should have a Medical Power of Attorney. Though it's tough to acknowledge, a day will likely come when you are no longer able to make your own healthcare decisions. Here are a few common occasions in which you might consider a PoA to be helpful:
Regardless of whether this Colorado Medical Power of Attorney has been prepared as part of a forward-looking plan or made as a result of an unexpected issue, witnesses and/or notarization are strongly encouraged as a best practice for protecting your document if anyone doubts its authenticity.
At times, in discussing the subjects of elder care and estate planning with medical or legal professionals, you might hear the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" being used together. In reality, they're the same. That said, please keep in mind that it's certainly possible to get power of attorney over affairs that are not related to health care. In that case, "proxy" typically is not the preferred term.
Colorado Medical PoA forms are normally straightforward; however, you or your agent may still need legal advice. Seeking out a legal professional to proofread your Colorado Medical Power of Attorney might be expensive. A more cost-effective way to get a second pair of eyes on your document would be through Rocket Lawyer attorney services. By signing up for a Premium membership, you can get your documents reviewed or send specific legal questions. You can rest assured that Rocket Lawyer is here to help.
The fees associated with finding and hiring a lawyer to write a Medical Power of Attorney might range anywhere from two hundred to five hundred dollars, depending on your location. When using Rocket Lawyer, you are not just filling out a Power of Attorney template. If you ever need assistance from a lawyer, your membership provides up to 40% in savings when you hire an attorney from our network.
When you're finished creating this Healthcare PoA using Rocket Lawyer, you'll be able to get to it anytime and anywhere. With a membership, you can make edits, save it in Word or PDF format, or sign it. Alongside each Power of Attorney form, there's a checklist of helpful tips on what you should do next. You should make sure that your agent(s), care providers, and other impacted parties get their copy of the final document.
The laws for PoA forms are different by state; however, in Colorado, neither witnesses nor notarization are legally required. That said, both are recommended to help reinforce the authenticity of your document. Finally, as a basic standard, witnesses will need to not be under 18 years old, and no witness should also be acting as your Power of Attorney agent.
See Colorado Medical/Healthcare Power of Attorney law: C.R.S. Title 15, Article 18.5
