Michigan Medical Power of Attorney Form

The Michigan medical power of attorney form is a legal document that is provided by a Principal to grant powers to a designated agent so that they might have the ability to make decisions with regard to their health care in the event the Principal is unable to communicate or act on their own behalf. This powers document will not become effective until the Principal is unable.

This document must be signed by two (2) witnesses.

How to Write

Step 1 – Parties –

  • Enter the name of the Principal
  • The name of the Principal’s city of residents
  • Enter the name of the Agent, referred to as Patient Advocate
  • Agent’s complete address
  • Principal must read the remainder of the section

Step 2 – Successor Agent – In the event the first Agent becomes unable or unwilling to serve:

  • Enter the name of a Successor Agent
  • Provide the address of the Successor Agent

Step 3 – The Principal must read A through F of this section –

  • Enter any special wishes regarding the Principals care in th lines provided on the form
  • The Principal must read the remaining information

Step 4 – Signatures – Must be signed before a Notary Public:

  • The Principal’s Signature
  • Date of the signature in mm/dd/yyyy format
  • Contract Number

Step 5 – Witnesses – Enter the following:

  • Printed Names of Both Witnesses
  • Witnesses Addresses
  • Signatures of each respective witness