California Medical Power of Attorney
This Medical Power of Attorney is governed by the laws of the State of California. It allows you to designate someone to make medical decisions on your behalf if you are unable to do so.
Principal Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip: ________________
- Date of Birth: ____________________
Agent Information:
- Name: ___________________________
- Address: _________________________
- City, State, Zip: ________________
- Phone Number: ____________________
Durability: This Medical Power of Attorney shall remain in effect until revoked by the Principal or until the Principal's death.
Authority Granted: The Agent shall have the authority to make medical decisions on behalf of the Principal, including but not limited to:
- Choosing healthcare providers.
- Consenting to or refusing medical treatment.
- Accessing medical records.
- Making decisions about life-sustaining treatment.
Signature:
By signing below, I confirm that I am the Principal and that I understand the contents of this document.
Principal's Signature: ______________________ Date: _______________
Witnesses: This document must be signed in the presence of two witnesses who are not related to the Principal and who are not entitled to any part of the Principal's estate.
Witness 1 Signature: ______________________ Date: _______________
Witness 2 Signature: ______________________ Date: _______________
Notary Public: If required, this document may also be notarized.
Notary Signature: _________________________ Date: _______________