 | Washington Medical Power of Attorney Form |
The Washington medical power of attorney form is a legal document that a Principal will provide to a designated Agent. The document will provide the ability for the Agent to act on behalf of the Principal, with regard to health care decisions, in the event the Principal is no longer able to communicate their own decisions. The Principal may also include durable powers if they so desire. The Principal may consider speaking with an attorney prior to completion of the document to be certain they understand clearly, the contents of the document. This document must be witnessed and may be revoked at the Principal’s discretion.
How to Write
Step 1 – Notice to Principal –
- The Principal must review all paragraphs contained in this section
- Carefully review the Creation of Durable Powers for Health Care
Step 2 – Designation of Health Care Agent and Alternate Agents – Submit the following:
- Principal’s full name
- AND
- Agent’s name
- Street address
- City, State and Zip Code
- Phone number
- Principal must review the statement
- AND
- Initial Agent’s name
- Alternate Agent’s name (optional)
- Address
- City, State and Zip Code
- Phone number
- AND
- Names of first and alternate Agents
- Name of second Alternate Agent
- Address
- City, State and Zip Code
- Phone number
Step 3 – General Statement of Authority –
- Principal’s Printed name at the top right of the page
- Review the General Statement
Step 4 – Special Provisions – Enter:
- Any special provisions available to your agent(s)
- Date the entry in dd/m/yyyy format
- Principal’s signature
Step 5 – Notarization –
- The notary public must witness the signature
- The notary will then be required to complete the remaining portion of the form
