Official Virginia Medical Power of Attorney Document

Official Virginia Medical Power of Attorney Document

The Virginia Medical Power of Attorney form is a legal document that allows individuals to designate a trusted person to make medical decisions on their behalf in case they become incapacitated. This form ensures that healthcare preferences are respected and that the appointed agent can act according to the individual's wishes. Understanding this form is crucial for anyone looking to prepare for future health-related decisions.

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When it comes to making healthcare decisions, having a clear plan in place is essential, especially for those times when you may not be able to voice your preferences. The Virginia Medical Power of Attorney form serves as a vital tool in this regard, allowing individuals to appoint a trusted person—often referred to as an agent—to make medical decisions on their behalf. This document not only empowers your chosen representative to act according to your wishes but also outlines your healthcare preferences, ensuring that your values and desires are respected even when you cannot communicate them. Understanding the key elements of this form, such as the designation of your agent, the specific powers granted, and the importance of witnessing and notarization, can help you navigate the complexities of medical care with confidence. By taking the time to complete this form, you are not only protecting your rights but also providing peace of mind for yourself and your loved ones during challenging times.

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Virginia Medical Power of Attorney

This Medical Power of Attorney is designed in accordance with the Virginia Health Care Decisions Act. It grants the authority to an appointed person, known here as the "Agent," to make health care decisions on behalf of the "Principal" when the Principal is unable to make such decisions themselves.

Principal Information

Principal's Full Name: ___________________________

Principal's Address: ___________________________

City: ___________________ State: VA Zip Code: __________

Principal's Date of Birth: _________________________

Agent Information

Agent's Full Name: ___________________________

Agent's Address: ___________________________

City: ___________________ State: __________ Zip Code: __________

Agent's Telephone Number: _________________________

Agent's Alternate Telephone Number: _________________________

Alternate Agent Information (Optional)

If the primary Agent is unable, unwilling, or unavailable to act as the Agent, an alternate Agent may act in their place. Providing an alternate Agent is optional.

Alternate Agent's Full Name: ___________________________

Alternate Agent's Address: ___________________________

City: ___________________ State: __________ Zip Code: __________

Alternate Agent's Telephone Number: _________________________

Alternate Agent's Alternate Telephone Number: _________________________

Powers Granted

This document grants the Agent the power to make all health care decisions on the Principal's behalf, including but not limited to:

  • Deciding on the start, stop, or refusal of medical treatments.
  • Accessing the Principal's medical records.
  • Making decisions concerning life-sustaining treatments.
  • Consenting to donate the Principal's organs upon death, if not otherwise specified.

Special Instructions

If the Principal has any specific wishes or limitations they wish to place on the Agent's authority, they may list them here:

_________________________________________________________________________

_________________________________________________________________________

Signatures

This document must be signed by the Principal, the Agent, and two witnesses to be considered valid and in effect.

Principal's Signature: _________________________ Date: __________

Agent's Signature: _________________________ Date: __________

Alternate Agent's Signature (If Applicable): _________________________ Date: __________

Witness #1 Signature: _________________________ Date: __________

Witness #2 Signature: _________________________ Date: __________

Witnesses confirm that the Principal appears to be of sound mind and under no duress or undue influence at the time of signing.

Conclusion

This Virginia Medical Power of Attorney becomes effective immediately upon the incapacitation of the Principal and remains in effect until the Principal is able to make decisions again or the document is revoked.

File Specifics

Fact Name Description
Purpose The Virginia Medical Power of Attorney allows an individual to appoint someone to make medical decisions on their behalf if they become unable to do so.
Governing Law This form is governed by the Virginia Code § 54.1-2981 to § 54.1-2992.
Signing Requirements The form must be signed by the principal in the presence of a notary public or two witnesses.
Revocation The principal can revoke the Medical Power of Attorney at any time, as long as they are mentally competent.
Durability This power of attorney remains effective even if the principal becomes incapacitated.
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