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OTHER NAMES Rhode Island Healthcare POA Rhode Island Healthcare Power of Attorney Rhode Island Medical POA Rhode Island Healthcare Proxy

What is a Rhode Island Medical Power of Attorney?

A Rhode Island Medical Power of Attorney is a legal document that grants a person or organization the authority to make health-related decisions for you, such as accepting or refusing a certain medical treatment, when you cannot do so. 
 
The person giving control is known as the "principal," and the individuals or organizations gaining authority are known as the "agents." Designed for Rhode Island residents, this Power of Attorney for health care is made for use in Providence County, Kent County, Washington County, and in every other part of the state. All Rhode Island Medical PoA forms from Rocket Lawyer can be tailored for your unique scenario. As a result of this legal document, your agent(s) can offer confirmation to healthcare facilities and other parties that they can legally act in your interest when you are not able.

When to use a Rhode Island Medical Power of Attorney:

  • You want to keep things clear and simple in case you're incapacitated in the future.
  • You have a surgery coming up, declining health, or have been diagnosed with a terminal illness.

Sample Rhode Island Medical Power of Attorney

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STATUTORY FORM

DURABLE POWER OF ATTORNEY FOR HEALTH CARE

 

WARNING TO PERSON EXECUTING THIS DOCUMENT

 

This is an important legal document which is authorized by the general laws of this state. Before executing this document, you should know these important facts:

 

You must be at least eighteen (18) years of age and a resident of the state of Rhode Island for this document to be legally valid and binding.

 

This document gives the person you designate as your Agent (the Attorney-in-Fact) the power to make health care decisions for you. Your Agent must act consistently with your desires as stated in this document or otherwise made known.

 

Except as you otherwise specify in this document, this document gives your Agent the power to consent to your doctor not giving treatment or stopping treatment necessary to keep you alive.

 

Notwithstanding this document, you have the right to make medical and other health care decisions for yourself so long as you can give informed consent with respect to the particular decision. In addition, no treatment may be given to you over your objection at the time, and health care necessary to keep you alive may not be stopped or withheld if you object at the time.

 

This document gives your Agent authority to consent, to refuse to consent, or to withdraw consent to any care, treatment, service, or procedure to maintain, diagnose, or treat a physical or mental condition. This power is subject to any statement of your desires and any limitation that you include in this document. You may state in this document any types of treatment that you do not desire. In addition, a court can take away the power of your Agent to make health care decisions for you if your Agent:

 

(1) Authorizes anything that is illegal,

(2) Acts contrary to your known desires, or

(3) Where your desires are not known, does anything that is clearly contrary to your best interests.

 

Unless you specify a specific period, this power will exist until you revoke it. You Agent's power and authority ceases upon your death.

 

You have the right to revoke the authority of your Agent by notifying your Agent or your treating doctor, hospital, or other health care provider orally or in writing of the revocation.

 

Your Agent has the right to examine your medical records and to consent to their disclosure unless you limit this right in this document.

 

This document revokes any prior Durable Power of Attorney for Health Care.

 

You should carefully read and follow the witnessing procedure described at the end of this form. This document will not be valid unless you comply with the witnessing procedure.

 

If there is anything in this document that you do not understand, you should ask a lawyer to explain it to you.

 

Your Agent may need this document immediately in case of an emergency that requires a decision concerning your health care. Either keep this document where it is immediately available to your Agent and alternate Agents or give each of them an executed copy of this document. You may also want to give your doctor an executed copy of this document.

 

. DESIGNATION OF HEALTH CARE AGENT. I, , of , do hereby designate and appoint:

 

Agent Name:

 

Address:

  ,

Phone: Home: Work:

Relation, if any:

 

(Insert the name and address of one individual only as your Agent to make health care decisions for you. None of the following may be designated as your Agent: (1) your treating health care provider, (2) a nonrelative employee of your treating health care provider, (3) an operator of a community care facility, or (4) a nonrelative employee of an operator of a community care facility.)

 

as my Attorney-in-Fact (Agent) to make health care decisions for me as authorized in this document. For the purposes of this document, "health care decision" means consent, refusal of consent, or withdrawal of consent to any care, treatment, service, or procedure to maintain, diagnose, or treat an individual's physical or mental condition.

 

. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. By this document I intend to create a Durable Power of Attorney for Health Care.

 

. GENERAL STATEMENT OF AUTHORITY GRANTED. Subject to any limitations in this document, I hereby 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, including, but not limited to, my desires concerning obtaining or refusing or withdrawing life-prolonging care, treatment, services, and procedures.

 

(If you want to limit the authority of your Agent to make health care decisions for you, you can state the limitations in paragraph 4 ("Statement of Desires, Special Provisions, and Limitations") below. You can indicate your desires by including a statement of your desires in the same paragraph.)

 

. STATEMENT OF DESIRES, SPECIAL PROVISIONS, AND LIMITATIONS. (Your Agent must make health care decisions that are consistent with your known desires. You can, but are not required to, state your desires in the space provided below. You should consider whether you want to include a statement of your desires concerning life-prolonging care, treatment, services, and procedures. You can also make your desires known to your Agent by discussing your desires with your Agent or by some other means. If there are any types of treatment that you do not want to be used, you should state them in the space below. If you want to limit in any other way the authority given your Agent by this document, you should state the limits in the space below. If you do not state any limits, your Agent will have broad powers to make health care decisions for you, except to the extent that there are limits provided by law.)

 

In exercising the authority under this Durable Power of Attorney for Health Care, my Agent shall act consistently with my desires as stated below and is subject to the special provisions and limitations stated below:

 

a. Statement of desires concerning life-prolonging care, treatment, services, and procedures:

 

I do not wish to make a statement about life-prolonging care, except as indicated below.

 

My Agent's authority the withholding or withdrawal of artificial feeding (artificially administered nutrition and hydration), except as for my comfort, or to alleviate pain.

 

b. Additional statement of desires, special provisions, and limitations regarding health care decisions:

 

(You may attach additional pages if you need more space to complete your statement. If you attach additional pages, you must date and sign EACH of the additional pages at the same time you date and sign this document.) If you wish to make a gift of any bodily organ you may do so pursuant to the Uniform Anatomical Gift Act.

 

. INSPECTION AND DISCLOSURE OF INFORMATION RELATING TO MY PHYSICAL OR MENTAL HEALTH. Subject to any limitations in this document, my Agent has the power and authority to do all of the following:

 

a. Request, review, and receive any information, verbal or written, regarding my physical or mental health, including, but not limited to, medical and hospital records;

b. Execute on my behalf any releases or other documents that may be required in order to obtain this information;

c. Consent to the disclosure of this information.

 

(If you want to limit the authority of your Agent to receive and disclose information relating to your health, you must state the limitations in paragraph 4, "Statement of Desires, Special Provisions, and Limitations," above.)

 

. SIGNING DOCUMENTS, WAIVERS, AND RELEASES. Where necessary to implement the health care decisions that my Agent is authorized by this document to make, my Agent has the power and authority to execute on my behalf all of the following:

 

a. Documents titled or purporting to be a "Refusal to Permit Treatment" and "Leaving Hospital Against Medical Advice";

b. Any necessary waiver or release from liability required by a hospital or physician.

 

. DURATION. (Unless you specify a shorter period in the space below, this power of attorney will exist until it is revoked.)

 

. DESIGNATION OF ALTERNATE AGENT. (You are not required to designate any Alternate Agents but you may do so. An Alternate Agent you designate will be able to make the same health care decisions as the Agent you designated in paragraph 1, above, in the event the Agent is unable or ineligible to act as your Agent. If the Agent you designated is your spouse, he or she becomes ineligible to act as your Agent if your marriage is dissolved.)

 

If the person designated as my Agent in paragraph 1 is not available or becomes ineligible to act as my Agent to make a health care decision for me or loses the mental capacity to make health care decisions for me, or if I revoke that person's appointment or authority to act as my Agent to make health care decisions for me, then I designate and appoint the following persons to serve as my Agent to make health care decisions for me as authorized in this document, such persons to serve in the order listed below:

 

FIRST ALTERNATE AGENT

 

Agent Name:

 

Address:

  ,

Phone: Home: Work:

 

. PRIOR DESIGNATIONS REVOKED. I revoke any prior Durable Power of Attorney for Health Care.

 

. SEVERABILITY. If any provision in 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.

 

DATE AND SIGNATURE OF PRINCIPAL

 

(YOU MUST DATE AND SIGN THIS POWER OF ATTORNEY)

 

I sign my name to this Statutory Form Durable Power of Attorney for Health Care on the _____ day of ____________________, _____, at , Rhode Island.

 

 

 

________________________________________

(You sign here)

 

(THIS DOCUMENT WILL NOT BE VALID UNLESS IT IS SIGNED BY TWO (2) QUALIFIED WITNESSES WHO ARE PRESENT WHEN YOU SIGN OR ACKNOWLEDGE YOUR SIGNATURE. IF YOU HAVE ATTACHED ANY ADDITIONAL PAGES TO THIS FORM, YOU MUST DATE AND SIGN EACH OF THE ADDITIONAL PAGES AT THE SAME TIME YOU DATE AND SIGN THIS POWER OF ATTORNEY.)

 

STATEMENT OF WITNESSES

 

This document must be witnessed by two (2) qualified adult witnesses. None of the following may be used as a witness:

 

1. A person you designate as your Agent or Alternate Agent;

2. A health care provider;

3. An employee of a health care provider;

4. The operator of a community care facility;

5. An employee of an operator of a community care facility;

6. A person related to you by blood, marriage, or adoption or entitled to any part of your estate.

 

I declare under penalty of perjury that the person who signed or acknowledged this document is personally known to me to be , that signed or acknowledged this document in my presence, that appears to be of sound mind and under no duress, fraud, or undue influence, that I am not the person appointed as attorney in fact by this document, and that I am not a health care provider; an employee of a health care provider; the operator of a community care facility; nor an employee of an operator of a community care facility.

 

I hereby make the further declaration under penalty of perjury that I am not related to by blood, marriage, or adoption, and to the best of my knowledge, I am not entitled to any part of the estate of upon the death of under a will now existing or by operation of law.

 

 

 

Witness Signature: ________________________________________

 

 

Date: _________________________

 

 

Witness Signature: _________________________________________

 

 

Date: ________________________

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Rhode Island Medical Power of Attorney FAQs

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  • How do I get Medical Power of Attorney in Rhode Island?

    It's fast and simple to grant or obtain the authority you might need using a free Rhode Island Medical Power of Attorney template from Rocket Lawyer:

    1. Make the document - Answer a few questions and we will do the rest
    2. Send and share - Discuss it with your agent or get legal advice
    3. Sign and make it legal - Optional or not, notarization/witnesses are encouraged

    This solution will often end up being much less time-consuming than hiring and working with a traditional lawyer. If necessary, you may prepare a Medical PoA on behalf of your spouse or another family member, and then help that person sign it when ready. Keep in mind that for a PoA form to be considered valid, the principal must be mentally competent at the time of signing. In the event that the principal is already unable to make their own decisions, a conservatorship generally will be required. In this scenario, it is important to speak to a lawyer .

  • Do I need to have a Power of Attorney for healthcare in Rhode Island?

    If you are over 18 years old, you should have a Medical Power of Attorney. Although it can be unpleasant to acknowledge, a day will likely come when you can no longer make your own medical decisions. Here are some typical situations in which you may find PoA forms to be useful:

    • You are facing the possibility of a medical procedure or a hospitalization
    • You are aging or have declining health
    • You have been given a terminal diagnosis
    • You have plans to live in a care facility

    Regardless of whether your Rhode Island Medical Power of Attorney has been drafted as part of a forward-looking plan or created in response to an emergency, witnesses and/or notarization can often help to protect your document if its authenticity is doubted by a third party.

  • Is there a difference between a Rhode Island Healthcare Proxy and a Rhode Island Medical Power of Attorney?

    In discussing the topics of elder care and/or estate planning with healthcare or legal professionals, you might find that the terms "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" are used together. At the end of the day, they're one and the same. That being said, please keep in mind that it is entirely possible to give power of attorney over affairs that are not health-related. In that case, "proxy" usually is not the preferred term.

  • Do I need to hire a lawyer to review my Rhode Island Medical PoA?

    Rhode Island Medical PoA forms are typically straightforward; however, you could still need legal advice. It can vary depending on whom you contact, but sometimes an attorney won't even agree to review a document if they did not draft it. A more favorable approach would be via attorney services at Rocket Lawyer. As a Premium member, you have the ability to ask for a document review from an attorney with relevant experience or ask other questions related to your Medical Power of Attorney. We're always here to support you.

  • How much would I traditionally need to pay to get a Power of Attorney form for health care in Rhode Island?

    The cost of hiring and working with the average attorney to generate a Medical Power of Attorney could range anywhere from two hundred to five hundred dollars, based on your location. Unlike the other sites you might stumble upon, Rocket Lawyer offers much more than a Power of Attorney template. If you ever require support from a lawyer, your Premium membership provides up to a 40% discount when you hire an attorney from our network.

  • Am I required to do anything else after writing a Rhode Island Medical Power of Attorney?

    With a membership, you can edit it, download it as a PDF document or Word file, and/or print it. To make your Power of Attorney legally binding, you need to sign it. Your agent(s) and care providers should receive copies of your fully executed document.

  • Does a Medical Power of Attorney need to be notarized, witnessed, and/or recorded in Rhode Island?

    The requirements and restrictions are different by state; however, in Rhode Island, your Power of Attorney will generally need notarization or the signatures of two witnesses. Your document must be notarized if your agent will have the power to direct your burial or cremation. Witnesses shouldn't include your healthcare provider or their employee, nor should they be the owners, operators, or employees of your community care facility. Only one of the witnesses may be legally related to you (such as a spouse, adopted child, or family member) or any other heir/beneficiary. As a general rule, witnesses should be 18 years old or older, and no witness should simultaneously be designated as your agent.

    See Rhode Island Medical/Healthcare Power of Attorney law: Chapter 23-4.10

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