Idaho Medical Power of Attorney Template
This Medical Power of Attorney is created in accordance with the laws of the State of Idaho. It allows you to designate an individual to make healthcare decisions on your behalf if you become unable to do so.
Principal Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Date of Birth: ______________________
Agent Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Phone Number: ______________________
Effective Date:
This Medical Power of Attorney shall become effective upon the determination that I am unable to make my own healthcare decisions as certified by a licensed physician.
Healthcare Decisions:
I grant my Agent the authority to make healthcare decisions on my behalf, including but not limited to:
- Choosing healthcare providers and facilities.
- Giving consent to or refusing medical treatment.
- Accessing my medical records.
- Making decisions regarding life-sustaining treatments.
Limitations:
The following limitations apply to my Agent’s authority:
- ________________________________________________________________
- ________________________________________________________________
Revocation:
This Medical Power of Attorney may be revoked by me at any time, provided that I do so in writing and communicate my decision to my Agent.
Signature:
By signing below, I confirm that I am of sound mind and that I understand the contents of this document.
______________________________
Signature of Principal
______________________________
Date
Witnesses:
This document must be signed in the presence of two witnesses or a notary public.
______________________________
Signature of Witness 1
______________________________
Date
______________________________
Signature of Witness 2
______________________________
Date
______________________________
Notary Public
______________________________
Date