Medical power of attorney form

What it shows

If you're in the hospital and can't speak, your doctors need someone with the legal right to answer for you. With no spouse or kids, that person has to be named on paper, signed the way your state wants. Pick your state to see the document that names your health care agent, under the name your state gives it, and the law it's in. You'll see whether it stands on its own or is one part of a combined advance directive, who must be in the room when you sign, who can't witness, and who can't be your agent.

Then, if you like, it builds a checklist: your agent, a backup, who'll witness, and who keeps copies. Every name is optional, and anything you skip prints as a line to fill in by hand.

How to use it

This organizes the rules, it isn't legal or medical advice. A lawyer licensed in your state can confirm the form and the signing fit your case, and your state's official code has the final word.

Medical POA, health care proxy, health care power of attorney: same thing?

Same job, different names. Texas calls it a Medical Power of Attorney, New York and Massachusetts a Health Care Proxy, and North Carolina a Health Care Power of Attorney. Illinois and Wisconsin say Power of Attorney for Health Care, Ohio a durable power of attorney for health care, and Florida a Designation of Health Care Surrogate. Michigan's is a patient advocate designation: its law has no fill-in form, and we found no general state form.

In California, Georgia and Pennsylvania it's one part of a combined advance directive. California's Part 1 names your agent and Part 2 gives your instructions. For the whole packet, with your living will, use the advance directive form.

Health care proxy form: New York and Massachusetts

Both states call the document a Health Care Proxy. Pick either state above to see the official form and its rules.

• New York (Pub. Health Law §2981): the state's form is optional. You sign and date it before 2 adult witnesses, who also sign, and the form says no notary is needed. Your agent and your alternate can't be witnesses.
• Massachusetts (M.G.L. c.201D §2): you sign before 2 adult witnesses, and your named agent can't be one of them.

Is a spouse automatically your health care proxy? Not exactly. In New York, if you never signed one, a hospital, nursing home or hospice picks a surrogate from a list in the law: a court-appointed guardian first, then a spouse or domestic partner, an adult child, a parent, a sibling and a close friend (Pub. Health Law §2994-d). With no spouse or kids, signing the proxy is how you choose who it is.

Is it the same as a power of attorney for money?

No, they're separate documents. North Carolina's health care power of attorney gives your agent no power over your money. Ohio's law for financial powers of attorney says it doesn't apply to health care decisions, which have their own sections. Your state's power of attorney form covers the money side.

Can you do one yourself, and what does it cost?

States publish these forms for you to fill in. New York's health department form says: "You don't need a lawyer or a notary, just two adult witnesses." Most state forms are optional: California's says "You are free to use a different form." Texas is stricter: its medical power of attorney must be "in substantially" the state's form.

In California, Texas, Florida, New York and Pennsylvania there's no state filing fee and nothing to file. California and North Carolina run optional registries that charge $10.

Who must be there when you sign

Two adult witnesses is the usual rule. California, Texas and Ohio let a notary stand in for both. North Carolina needs 2 witnesses and a notary. Illinois needs 1 witness and no notary. Florida, New York, Georgia and Michigan want 2 witnesses with no notary route, and in Pennsylvania a notary is optional on top of the 2.

Who can't witness when you have no family

Bans on relatives cost you nothing when you have none. The limits that bite are the bans on your agent, on your heirs or will beneficiaries (often the friends or charity you named), and on care staff. Your agent can never witness in California, Florida or New York. North Carolina, Georgia and Michigan bar heirs and beneficiaries. California bars your health care provider and care home staff, North Carolina bars paid staff of your hospital or nursing home, and Georgia allows only one facility employee.

If you'll sign in a hospital or nursing home, a notary route helps where there is one. In North Carolina a facility's staff notary can notarize, but can't also be a witness.

Who can be your agent, and who can't

A friend can be your agent in California, Texas, Florida, New York and Pennsylvania. Most states we read bar your treating provider, and staff of the place caring for you unless related to you: California, Texas, New York, Pennsylvania and Ohio among them. Florida takes any competent adult. North Carolina bars anyone paid to give you health care.

Two rules to know if you'd name a friend. In New York, a friend who's already the agent for ten people can't be named. In Michigan, your patient advocate must sign an acceptance before acting, and can't be paid, only reimbursed for expenses. See agent rules by state.

In Canada

Switch to Canada for the 10 provinces and 3 territories. In Ontario it's a power of attorney for personal care, which names your attorney for personal care. You sign before 2 witnesses, who can't be your attorney or their spouse or partner, your spouse or partner, your child, or anyone under 18. Someone paid to give you care can't be your attorney unless they're your spouse, partner or relative. Elsewhere it's a representation agreement in British Columbia, a personal directive in Alberta, Nova Scotia and the Northwest Territories, and a protection mandate in Québec, which a court must approve before it takes effect. The other provinces and Yukon use a directive that can name someone. By a secondary source's account, Nunavut has no directive law at all. British Columbia, New Brunswick and Nova Scotia bar most paid caregivers who aren't family, while Alberta, Manitoba and Newfoundland and Labrador set only age and capacity limits.

Where the facts come from

This is the same research as the advance directive form, narrowed to the document that names your agent. We read each state's law, including the agent-document rules (how to sign it, whether it's its own form, and who can't be your agent), on its own code site or agency page where we could, in October 2026. Where a site blocked us, we read a mirror copy of the code, and the page flags that state. Where we saw only a search summary or a law firm's note, it says "Not confirmed: check your state's official site." Delaware (2025) and Utah (2026) moved to a new uniform law, so older guides for those two states are out of date.

Read next

• Medical power of attorney: what it does and how to sign it.
• Health care proxy with no family or friends: who to name.
• Agent rules by state: who can and can't serve.
• living will form: the document that holds your treatment wishes, under your state's name for it.

Other free tools

• Advance directive form: the whole packet, with your living will.
• Living will template: write your treatment wishes step by step, then print them.
• Power of attorney form: the money side, your state's official financial form.
• Emergency contact card: a wallet card that names your health care agent.

This page isn't legal or medical advice and doesn't make a medical power of attorney for you. Laws change, so check your state's official code before you sign.