This Alabama Medical Power of Attorney is established in accordance with the Alabama Uniform Power of Attorney Act, empowering an individual to make healthcare decisions on another's behalf when they are unable to do so. This document serves as a directive for healthcare providers regarding the principal's medical care preferences.
Principal Information
- Full Name: _______________________
- Address: ________________________
- City, State, ZIP: _________________
- Phone Number: ___________________
Agent Information
- Full Name: _______________________
- Address: ________________________
- City, State, ZIP: _________________
- Phone Number: ___________________
Alternate Agent Information (Optional)
If the primary agent is unable or unwilling to act, the person listed below is designated as the alternate agent:
- Full Name: _______________________
- Address: ________________________
- City, State, ZIP: _________________
- Phone Number: ___________________
Authority Granted to the Agent
This Medical Power of Attorney authorizes the agent to make all health care decisions for the principal, including but not limited to:
- Decision-making authority regarding medical care, surgical procedures, and life-sustaining treatments.
- Access to medical records and information pertinent to the principal's health status.
- The power to select or discharge healthcare providers and institutions.
- Consent to refuse or withdraw consent for any type of medical intervention, including life-sustaining treatment.
- Consent to admission to or discharge from a healthcare facility.
Special Instructions (Optional)
The principal may provide additional instructions or limitations regarding the healthcare agent's authority:
Duration of the Power of Attorney
This Medical Power of Attorney becomes effective immediately upon the incapacitation of the principal and remains in effect indefinitely unless a specific termination date is provided here:
- Termination Date (if applicable): _________
Signatures
This Power of Attorney must be signed by the principal, the agent, and an alternate agent (if designated). It is also recommended, though not required by Alabama law, to be signed in the presence of two witnesses or a notary public to substantiate the document's authenticity.
Principal's Signature: ___________________ Date: _________
Agent's Signature: _______________________ Date: _________
Alternate Agent's Signature (If Applicable): ___________________ Date: _________Witnesses (Optional)
The undersigned witnesses confirm that the principal appears to be of sound mind and free from duress or undue influence at the time of document signing.
- Witness 1 Signature: ___________________ Date: _________
- Witness 2 Signature: ___________________ Date: _________