Sample Form: The Durable Power of Attorney for Health Care
The Legal Rights Service has designed a standardized durable power of attorney for health care form with clauses to specify instructions for mental health treatment. Call Legal Rights Service to order copies or download the Durable Power of Attorney for Health Care form (PDF file) from the Legal Rights Service web site. You may download and make copies of the form for personal and other non-profit use.
This standardized durable power of attorney for health care form is designed to help you direct your care if your doctor decides that you lack capacity to make your own medical decisions. The form is not intended as legal advice. You should consult a lawyer if you have questions about this form and your own particular circumstances.