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West Virginia Medical Power of Attorney Form

The West Virginia medical power of attorney form is a legal document that would be completed by a Principal, authorizing powers to an Agent of their choice, to make health care decisions on their behalf, once the Principal is no longer able to direct their own health care. Once the health of the Principal has diminished to this point, the Agent will be responsible to apply the health care directives as strictly as possible, to the wishes of the Principal. This document may be revoked should the Principal wish to do so, whenever they wish. This document must be attested by two witnesses and a notary public before it can be effective.

How to Write

Step 1 – The Parties – Enter:

  • Date the document in mm/dd/yy format
  • Principal’s name and address
  • AND
  • Agent’s name
  • Address
  • Area code and phone number
  • AND
  • Successor Agent’s name
  • Address
  • Area code and phone number
  • Read the remaining information

Step 2 – Special Directives or Limitations –

  • Provide any special instructions to limit powers for the Agent
  • Read the statement
  • Submit Principal’s signature

Step 3 – Witness Attestation –

  • Read and agree to the attestation statement
  • Enter witnesses signatures
  • Date signatures in mm/dd/yyyy format

Step 4 – Notarization –

  • After witnessing the signatures on the form, the notary will complete the required information, in acknowledgement of the validity of the document

Related Forms

West Virginia Tax Power of Attorney Form West Virginia Durable Financial Power of Attorney Form West Virginia General Financial Power of Attorney Form West Virginia Limited (Special) Power of Attorney Form West Virginia Minor Child Power of Attorney Form West Virginia Revocation Power of Attorney Form