Oklahoma Medical Power of Attorney Form

The Oklahoma medical power of attorney form is a document that will permit the Principal to appoint an Agent to advocate on behalf of the Principal’s health care only. There will be no other powers granted with this document, regarding money, financial accounts, personal property or real property.

The Principal should take the time to read through the document to be certain they understand the documents contents. If, in fact, the Principal needs assistance, as opposed to hiring an attorney, there are resources listed at the top of the first page of the document for assistance, unless The Principal would feel more comfortable contacting their own counsel.

This document will require that signatures occur before a Notary Public. This document may be revoked at the discretion of the Principal with written and notarized notice, delivered or served to the Agent.

How to Write

Step 1 – Parties – Principal must enter the following:

  • The Principal’s full name and address
  • AND
  • Enter the name and address for the appointed Agent
  • AND

Should the initial Agent become unable to serve, the Principal may choose an alternate Agent, if so, enter:

  • The name and address of the Alternate Agent

Step 2 –  Read this statement:

“Once effective pursuant to section III on the back of this form, this power of attorney will continue to be effective even though I become disabled, incapacitated, or incompetent, and shall not be affected by lapse of time”

In the event the Principal does not agree with this statement or this does not reflect the wishes of the Principal, they must simply strike it out by X-ing through the entire statement or draw a line through each sentence and initial it to either side.

Step 3 – Grant of Health Care Powers –

  • This section will allow the Principal to select some or all of the powers present on this document. If the Principal reads all of the powers before initialing any of them, and they wish to simply grant all of the powers, they only need to initial line “F”
  • If the Principal would like to choose only specific powers, read each power and initial only the lines that reflect their wishes with regard to allowable powers. Choose from the powers A through F.
  • Read number 2 of this section and be certain to inform your family members

Step 4 – Additional Guidance and Information (Optional) –

  • Read each statement (A through E) and answer in the lines provided.
  • This is optional, but completion of this section may be helpful for the Agent to assist in a much better understanding of the Principal’s more intimate thoughts with regard to spiritual matters, fears, goals and even how they feel their end of life experience may affect family

Step 5 – Special Instructions –

  • The Principal may use this section to place into writing, limitations, restrictions or expansions pertaining to their powers and wishes. Use the lines provided

Step 6 – When Power Becomes Effective –

  • The Principal must enter their initials in the line preceding one of the two statements, indicating the Principals choice as to when the document shall become effective

Step 7 – Third Party Statement –

  • The Principal must read the statement.
  • If in agreement, the Principal must enter their signature
  • AND
  • Enter the City, County and State of Residence

Step 8 – Witness Attestations -The witnesses must read the attestation paragraph provided. If in agreement enter the following:

  • Both witnesses must enter their respective signatures indicating that they have read and agree to the witness attestation

Step 9 – Notarization –

When the document has been completed and reviewed by all of the signatories, the Notary shall witness their signatures. The Notary will acknowledge the document by providing all of the state required Notary Public information and by provision of the official seal