The Missouri Medical Power of Attorney form allows individuals to designate a trusted person to make healthcare decisions on their behalf when they are unable to do so. This legal document ensures that your medical preferences are honored, even if you cannot communicate them. To take control of your healthcare decisions, consider filling out the form by clicking the button below.
In the realm of healthcare decision-making, the Missouri Medical Power of Attorney form serves as a crucial tool for individuals seeking to ensure their medical preferences are honored when they are unable to communicate their wishes. This form allows a person, often referred to as the principal, to designate a trusted individual, known as the agent, to make medical decisions on their behalf. The form encompasses various aspects, including the authority granted to the agent, the types of medical treatments that can be accepted or declined, and any specific wishes regarding end-of-life care. By completing this document, individuals can articulate their values and desires regarding healthcare, thus alleviating the burden on family members during challenging times. Importantly, the Missouri Medical Power of Attorney is not just a one-size-fits-all document; it allows for customization based on personal beliefs and circumstances. Moreover, understanding the implications of this form can empower individuals to take control of their healthcare decisions, fostering a sense of peace and assurance that their choices will be respected. With the right knowledge and preparation, anyone can navigate the complexities of medical decision-making, ensuring their voice remains heard even in the most trying situations.
Missouri Medical Power of Attorney
This Missouri Medical Power of Attorney is a legal document that allows an individual (the "Principal") to designate another person (the "Agent") to make health care decisions on their behalf should they become unable to do so. This document is made pursuant to the Missouri Durable Power of Attorney for Health Care Act.
Principal Information
Full Name: _____________________________
Address: ______________________________
City: _____________________ State: MO Zip Code: _________
Phone Number: _________________________
Agent Information
Relationship to Principal: _______________
Alternate Phone Number: ________________
Alternate Agent Information (Optional)
General Statement of Authority Granted
When the Principal is unable to make or communicate health care decisions, the Agent named above is authorized to make medical and health care decisions on behalf of the Principal. This includes decisions regarding the withholding or withdrawal of life-sustaining treatment and the power to approve or disapprove medical procedures, services, or interventions.
Special Instructions
Please list any specific limitations you wish to place on the Agent's authority, specific treatments you do or do not want, or any other special instructions:
________________________________________________________________
Duration
This Medical Power of Attorney remains in effect until the Principal's death, unless the Principal revokes it in writing or specifies a different date or condition for its termination.
Signature
By signing below, the Principal acknowledges that they have read and understand the contents of this document and affirm this as their act and deed. This Medical Power of Attorney must be signed in the presence of two witnesses or a notary public.
Principal's Signature: ___________________________ Date: ____________
Witness 1 Signature: ____________________________ Date: ____________
Witness 2 Signature: ____________________________ Date: ____________
Notarization (If applicable)
This section should be completed by a notary public if the Principal wishes to notarize this document.
State of Missouri )
County of ___________ )
Subscribed and sworn before me this _____ day of ___________, 20___
Notary Public Signature: ___________________________________
My commission expires: _____________________________________
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