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DURABLE POWER OF ATTORNEY FOR HEALTH CARE
. 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: None of the following individuals may be appointed or act as your Health Care Agent:
(1) your treating health care provider,
(2) an employee of your treating health care provider,
(3) an operator of a community care facility or residential care facility,
(4) an employee of an operator of a community care facility or residential care facility.
EXCEPT any employee of the above institutions may be designated as the Attorney-in-Fact if the employee so designated is related to you by blood, marriage or adoption.
. CREATION OF DURABLE POWER OF ATTORNEY FOR HEALTH CARE. By this document I intend to create a Durable Power of Attorney for Health Care. This power of attorney takes effect when my primary physician or supervising health care provider determines that I lack the capacity to make my own health care decisions. My agent's authority to make health care decisions for me becomes effective as necessary immediately upon my execution of this Power of Attorney for Health Care.
. 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.
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)
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 |
A notary public
two witnesses who then sign the document in your presence and in each other's presence.of a notary who then notarizes the document.
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It is very simple to grant or receive the authority you might need using a free Wyoming Medical Power of Attorney template from Rocket Lawyer:
This method is, in most cases, much less expensive than hiring and working with your average lawyer. If needed, you may fill out this Medical PoA on behalf of your spouse or another family member, and then help that person sign it once you've drafted it. Please remember 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. If the principal has already been declared incompetent, a court-appointed conservatorship could be necessary. When dealing with this scenario, it would be a good idea for you to work with a lawyer .
If you are over 18 years old, you should have a Medical Power of Attorney. While it's challenging to acknowledge, a time will likely come when you aren't able to make your own healthcare decisions. Here are some typical circumstances in which you might consider a PoA to be helpful:
Whether your Wyoming Medical Power of Attorney has been drafted as part of a long-term plan or created in response to an emergency, notarization and/or witnesses can often help to protect your document if its legitimacy is doubted by a third party.
Sometimes, in the process of researching the subjects of estate planning and elder care, you or a loved one might hear "healthcare power of attorney", "medical power of attorney" and "healthcare proxy" being used together. In reality, they are one and the same. That being said, you should keep in mind that it's entirely possible to grant power of attorney over affairs that aren't health-related. In that case, "proxy" is not normally used.
Wyoming Medical PoA forms are usually simple to make; however, you or your agent could still need legal advice. Hiring an attorney to check your Wyoming Medical Power of Attorney may be costly. An easier and more cost-effective way to get a second pair of eyes on your document would be to go through the On Call network. If you become a Premium member, you can have your documents evaluated by an experienced attorney. As always, Rocket Lawyer is here for you.
The fees associated with hiring a law firm to make a Medical Power of Attorney might total between two hundred and five hundred dollars, depending on your location. When you use Rocket Lawyer, you are not just filling out a Power of Attorney template. In case you ever require help from a lawyer, your Premium membership offers up to a 40% discount when you hire an attorney from our Rocket Lawyer attorney network.
With a Rocket Lawyer membership, you may make edits, save it in Word or PDF format, or print it out. When you are ready to finalize your Power of Attorney, it must be signed. You should provide a final copy of the signed document to your agent(s) and care providers.
The specific guidelines and restrictions for PoA forms will be different by state; however, in Wyoming, your document will need to be signed by a notary public or two witnesses. Your chosen witnesses cannot be operators or employees of any healthcare or residential/community care facilities providing your care. As a general rule, witnesses must not be under the age of 18, and no witness should also be named as your PoA agent.
See Wyoming Medical/Healthcare Power of Attorney law: Title 35, Ch. 22, Article 4
