Delaware Medical Power of Attorney
This document serves as a Medical Power of Attorney in accordance with the laws of the State of Delaware. It allows you to designate someone to make healthcare decisions on your behalf in the event that you are unable to do so.
Principal Information:
- Name: ________________________________
- Address: ______________________________
- City: _________________________________
- State: ________________________________
- Zip Code: _____________________________
- Date of Birth: _________________________
Agent Information:
- Name: ________________________________
- Address: ______________________________
- City: _________________________________
- State: ________________________________
- Zip Code: _____________________________
- Phone Number: _________________________
Instructions for Healthcare Decisions:
In the event that I am unable to make my own healthcare decisions, I grant my agent the authority to make decisions regarding my medical treatment, including but not limited to:
- Choosing healthcare providers.
- Accessing my medical records.
- Making decisions about life-sustaining treatments.
- Consenting to or refusing medical procedures.
Limitations on Agent's Authority:
My agent shall not have the authority to make decisions regarding:
- Any treatment that is contrary to my expressed wishes.
- Organ donation, unless I have provided specific instructions.
Signature:
By signing below, I affirm that I am of sound mind and that I understand the contents of this document.
Principal Signature: ___________________________
Date: ______________________________________
Witnesses:
Two witnesses are required to sign below. They must be at least 18 years old and cannot be named as agents in this document.
Witness 1 Signature: ___________________________
Date: ______________________________________
Witness 2 Signature: ___________________________
Date: ______________________________________
Notary Public:
This document should be notarized to ensure its validity.
Notary Signature: _____________________________
Date: ______________________________________