MAKE YOUR FREE Massachusetts Medical Power of Attorney
What is a Massachusetts Medical Power of Attorney?
The person granting control is called the "principal," while the individuals or entities gaining authority are called the "agents." Suitable for Massachusetts residents, this Power of Attorney for health care is made for use in Middlesex County, Worcester County, Suffolk County, and in all other parts of the state. All Massachusetts Medical PoA forms from Rocket Lawyer can be modified to address your unique scenario. This essential legal document will provide confirmation to medical providers and other parties that your chosen agent(s) can make choices for you.
When to use a Massachusetts Medical Power of Attorney:
- You have someone you trust willing to make medical decisions for you if you become unable, and you need it to be official.
- You have concerns about your health and want to take every precaution.
Sample Massachusetts Medical Power of Attorney
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INFORMATION CONCERNING THE HEALTH CARE PROXY
THIS IS AN IMPORTANT LEGAL DOCUMENT. BEFORE SIGNING THIS DOCUMENT YOU SHOULD KNOW THESE IMPORTANT FACTS:
Except to the extent you state otherwise, this document gives the person you name as your Agent the authority to make MOST health care decisions for you if you cannot make the decisions for yourself. You may include specific limitations in this document on the authority of your Agent to make health care decisions for you.
Even after you have signed this document, you have the right to make health care decisions for yourself as long as you are able to do so. In addition, after you have signed this document, no treatment may be given to you or stopped over your objection if you are mentally competent to make that decision.
You should inform the person you appoint that you want the person to be your Health Care Agent. You may state in this document any type of treatment that you do not desire and any that you want to make sure you receive. You should discuss this document and your wishes, values and preferences regarding your health care with your Agent.
Your Agent is obligated to follow your desires or if your desires are unknown, to act in your best interest. Your Agent is not liable for health care decisions made in good faith on your behalf. Unless you state otherwise, your Agent has the same authority to make decisions about your health care as you would have had. A physician must comply with your Agent's instructions or allow you to be transferred to another physician.
The person you appoint as your Agent should be someone you know and trust. The person must be an adult. Generally you cannot appoint your health or residential care provider (e.g., your physician or an employee of a home health agency, hospital, nursing home, or residential care home) to be your Agent, unless that person is related to you.
You may wish to designate an Alternate Agent in the event that your Agent is unwilling, unable, or ineligible to act as your Agent. Any Alternate Agent you designate has the same authority to make health care decisions for you.
You have the right to revoke the authority granted to your Agent by informing your Agent or your health or residential care provider orally or in writing, or by your execution of a subsequent durable power of attorney for health care. Unless you state otherwise, generally your appointment of a spouse dissolves on divorce.
This document may not be changed or modified. If you want to make changes in the document, you must make an entirely new one.
It is important that you discuss this document with your physician or other health care provider before you sign it to make sure that you understand the nature and range of decisions that may be made on your behalf. If you do not have a physician, you should talk with someone else who is knowledgeable about these issues and can answer your questions.
You should keep a copy of this document after you have signed it. Give a copy to the person you name as your Agent or alternate. You should indicate on the document itself the people and institutions who have signed copies. If you are in a health care facility, a copy of this document should be included in your medical record.
You do not need a lawyer's assistance to complete this document, but if there is anything in this document that you do not understand, you should ask a lawyer to explain it to you.
HEALTH CARE PROXY
. 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.
. CREATION OF HEALTH CARE PROXY. By this document I intend to create a Health Care Proxy. This document 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, the authority to direct the withdrawal and withholding of artificially provided food and fluids.
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.
SECOND ALTERNATE AGENT
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
. 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
IN THE PRESENCE OF TWO WITNESSES)
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, , (the "Principal") has identified himself or herself to me, that signed or acknowledged this document in my presence, that appears to be of sound mind, and under no duress, fraud or undue influence, and at least eighteen years of age. 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 am at least eighteen years of age.
| Witness Signature: | ________________________________________ |
Date: _________________________
| Witness Signature: | ________________________________________ |
Date: _________________________
Massachusetts Medical Power of Attorney FAQs
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Can I get a Massachusetts Medical Power of Attorney form for free?
It's quick and easy to give or get the support you may need with a free Massachusetts Medical Power of Attorney template from Rocket Lawyer:
- Make the PoA - Provide a few basic details and we will do the rest
- Send or share it - Look over the document with your agent or ask a legal question
- Sign it - Optional or not, notarization and witnesses are recommended
This route will often be much more affordable and convenient than finding and hiring a traditional lawyer. If needed, you may fill out a Medical PoA on behalf of your spouse or another relative, and then help them sign after you've drafted it. Please note that for a PoA form to be accepted as legally valid, the principal must be an adult who is mentally competent at the time of signing. In the event that the principal has already been declared incompetent, a court-appointed conservatorship could be required. In this scenario, it would be best for you to work with an attorney .
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Do I need to have a Power of Attorney for healthcare in Massachusetts?
If you are over 18 years old, you should have a Medical Power of Attorney. While it may be painful to think about, a time could come when you can no longer make your own healthcare decisions. Typical situations where you may consider power of attorney to be useful include:
- You are facing the possibility of surgery or a hospitalization
- You are aging or have declining health
- You've been given a terminal diagnosis
- You intend to move into an adult care facility
Whether this Massachusetts Medical Power of Attorney has been generated as part of a long-term plan or made in response to an unexpected emergency, witnesses and notarization can often help to protect your document if a third party doubts its credibility.
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How are a Massachusetts Healthcare Proxy and a Massachusetts Medical Power of Attorney different?
Sometimes, in researching the topics of estate planning and elder care, you might see the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together or interchangeably. At the end of the day, they are the same. That said, please keep in mind that it's absolutely possible to grant agency over matters that are not related to medical care, in which case, "proxy" is not generally used.
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Do I need to work with a lawyer to review my Massachusetts Medical PoA?
Massachusetts Medical PoA forms are typically simple to make; however, you or your agent(s) might have legal questions. Finding a lawyer to give feedback on your Massachusetts Medical Power of Attorney could be relatively time-intensive. An easier option is to go through attorney services at Rocket Lawyer. With a Premium membership, you can get your document reviewed or send any legal questions. As always, Rocket Lawyer is here to help.
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What might I typically need to pay to get a Power of Attorney form for health care in Massachusetts?
The fees associated with finding and working with the average law firm to produce a Medical Power of Attorney could total between two hundred and five hundred dollars, depending on your location. Unlike other Power of Attorney template providers that you may find, Rocket Lawyer gives Premium members up to 40% in savings when hiring a lawyer, so an Rocket Lawyer network attorney can represent you if you ever need support.
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Am I required to do anything else after creating a Massachusetts Medical Power of Attorney?
With a Rocket Lawyer membership, you can make edits, save it as a Word or PDF file, or print it out. When you are ready to complete your Power of Attorney, it needs to be signed. You will need to provide a final copy of the fully signed document to your agent(s) and care providers.
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Does a Medical Power of Attorney need to be notarized, witnessed, or recorded in Massachusetts?
The specifications and restrictions vary in each state; however, in Massachusetts, your Power of Attorney must be signed by two witnesses. Finally, as a basic principle, your witness(es) will need to not be under 18 years old, and no witness should also be named as your Power of Attorney agent.
See Massachusetts Medical/Healthcare Power of Attorney law: § 201D-2
