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 4.5K times
Legally binding and enforceable
Ask a lawyer questions about your document
POWER OF ATTORNEY FOR HEALTH CARE
. DESIGNATION OF HEALTH CARE AGENT. I appoint:
| Agent Name: |
| Address: |
| , |
| Phone: | Home: Work: |
| Relation, if any: |
as my Attorney-in-Fact ("Agent") for Health Care. I authorize my Attorney-in-Fact appointed by this document to make health care decisions for me when I am determined to be incapable of making my own health care decisions. I have read the warning which accompanies this document and understand the consequences of executing a Power of Attorney for Health Care.
None of the following may serve as your Attorney-in-Fact:
(1) Your attending physician;
(2) An employee of your attending physician who is not related to you by blood, marriage, or adoption;
(3) A person not related to you by blood, marriage, or adoption who is an owner, operator, or employee of a health care provider in or of which you are a patient or resident; and
(4) A person not related to you by blood, marriage, or adoption if, at the time of the proposed designation, he or she is personally serving as an Attorney-in-Fact for ten or more Principals.
. CREATION OF POWER OF ATTORNEY FOR HEALTH CARE. By this document I intend to create a Power of Attorney for Health Care. This document shall take effect when I am incapable of making health care decisions for myself. In other words, my Agent shall have the authority to make health care decisions for me if I am unable to understand and appreciate the nature and consequences of health care decisions, including the benefits of, risks of, and alternatives to proposed health care or I am unable to communicate in any manner regarding any informed health care decision. This power of attorney shall continue during any period of my incapacity.
. 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.
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. I specifically grant to my Agent the authority to consent to the withholding or withdrawing of life-sustaining procedures, as permitted by law,
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
IN THE PRESENCE OF TWO WITNESSES OR A NOTARY PUBLIC)
I HAVE READ THIS DOCUMENT. I UNDERSTAND THAT IT ALLOWS ANOTHER PERSON TO MAKE LIFE AND DEATH DECISIONS FOR ME IF I AM INCAPABLE OF MAKING SUCH DECISIONS. I ALSO UNDERSTAND THAT I CAN REVOKE THIS POWER OF ATTORNEY FOR HEALTH CARE AT ANY TIME BY NOTIFYING MY ATTORNEY IN FACT, MY PHYSICIAN, OR THE FACILITY IN WHICH I AM A PATIENT OR RESIDENT. I ALSO UNDERSTAND THAT I CAN REQUIRE IN THIS POWER OF ATTORNEY FOR HEALTH CARE THAT THE FACT OF MY INCAPACITY IN THE FUTURE BE CONFIRMED BY A SECOND PHYSICIAN.
Signed on _____ day of _______________, _____.
| Signature: | ________________________________________ |
| Name: |
| Address: |
| County |
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's very simple to grant or obtain the support you may need with a free Nebraska Medical Power of Attorney template from Rocket Lawyer:
This solution, in most cases, will end up being much more affordable than working with the average provider. If necessary, you can start a Medical PoA on behalf of a relative, and then help that person sign when ready. Please remember that for this document to be accepted as legally valid, the principal must be an adult who is mentally competent when they sign. In the event that the principal has already been declared legally incompetent, a court-appointed conservatorship generally will be necessary. In this scenario, it is important to speak to a lawyer .
Anyone who is over 18 should have a Medical Power of Attorney. Though it is unpleasant to acknowledge, there may come a day when you can no longer make healthcare decisions on your own. Typical occasions where you might consider a PoA to be useful include:
Whether your Nebraska Medical Power of Attorney has been prepared as part of a forward-looking plan or made as a result of an unexpected emergency, witnesses and/or notarization are highly recommended as a best practice for protecting your document if its lawfulness is doubted.
At times, in the process of researching the topics of elder care and estate planning, you or a loved one may hear "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" used together or interchangeably. At the end of the day, they are one and the same. That said, you should keep in mind that it's possible to give agency over matters that are not related to health care. In that case, "proxy" is not normally used.
Nebraska Medical PoA forms are typically straightforward; however, you or your agent may still have legal questions. Hiring an attorney to provide feedback on your Nebraska Medical Power of Attorney can be expensive. An easier and more cost-effective route is to request help from the Rocket Lawyer attorney network. As a Premium member, you can have your document examined by an Rocket Lawyer network attorney with relevant experience. As always, you can rest assured that Rocket Lawyer is by your side.
The fees associated with hiring the average attorney to create a Medical Power of Attorney could add up to anywhere from two hundred to five hundred dollars, depending on your location. Different from many other Power of Attorney template providers that you might find elsewhere, Rocket Lawyer offers Premium membership holders up to a 40% discount when hiring a lawyer, so an attorney can represent you if you ever need help.
With a Rocket Lawyer membership, you may make edits, download it as a PDF document or Word file, and print it. In order to make this drafted PoA into a true legal document, you will need to sign it. Your agent(s) and care providers should receive a copy of the fully executed document.
The specifications vary in each state; however, in Nebraska, your Power of Attorney will need to be acknowledged by a notary public or signed by two witnesses. Witnesses to your PoA form should not be your relative/spouse, heirs, or other beneficiaries. As a basic standard, witnesses will need to not be under 18 years old, and no witness should simultaneously be acting as your agent.
See Nebraska Medical/Healthcare Power of Attorney law: § 30-3403
