Wyoming Medical Power of Attorney
This Medical Power of Attorney is created in accordance with the laws of the State of Wyoming. It allows you to designate someone to make medical decisions on your behalf if you become unable to do so.
Principal Information:
- Full Name: ________________________________________
- Address: ________________________________________
- City, State, Zip Code: __________________________
- Date of Birth: ___________________________________
Agent Information:
- Full Name: ________________________________________
- Address: ________________________________________
- City, State, Zip Code: __________________________
- Phone Number: ___________________________________
Durability: This Medical Power of Attorney shall remain in effect even if I become incapacitated.
Limitations: The authority granted to my agent is limited to the following:
- Making decisions regarding my medical treatment.
- Accessing my medical records.
- Consenting to or refusing medical procedures on my behalf.
Revocation: This document may be revoked by me at any time, provided that I communicate my decision to my agent and any relevant healthcare providers.
Signatures:
By signing below, I affirm that I am of sound mind and that I understand the contents of this Medical Power of Attorney.
Principal's Signature: ________________________________
Date: ____________________________________________
Witness Signature: _________________________________
Date: ____________________________________________
Notary Public: ______________________________________
Date: ____________________________________________