Colorado Medical Power of Attorney Template
This Medical Power of Attorney is created in accordance with the Colorado Revised Statutes, Title 15, Article 14, which governs medical decision-making authority.
Principal Information:
- Name: _______________________________
- Address: _____________________________
- City, State, Zip: _____________________
- Date of Birth: ________________________
Agent Information:
- Name: _______________________________
- Address: _____________________________
- City, State, Zip: _____________________
- Phone Number: ________________________
Durable Medical Power of Attorney:
I, the undersigned Principal, hereby designate the above-named Agent to act on my behalf in making medical decisions for me in the event that I am unable to make those decisions myself. This authority includes, but is not limited to, the following:
- Consent to or refuse medical treatment.
- Access my medical records and information.
- Make decisions regarding life-sustaining treatment.
This Medical Power of Attorney shall remain in effect until revoked by me in writing or until my death.
Signature: ___________________________
Date: ______________________________
Witness Information:
- Name: _______________________________
- Address: _____________________________
- Signature: ____________________________
- Date: ________________________________
Notary Public:
State of Colorado, County of ________________
Subscribed and sworn to before me this ____ day of __________, 20__.
My commission expires: ________________
Notary Signature: _______________________