Homepage Attorney-Verified Minnesota Medical Power of Attorney Form
Outline

When individuals consider planning for the future, especially in terms of healthcare decisions, the Minnesota Medical Power of Attorney form often comes to the forefront. This vital document plays an essential role in allowing a person to appoint someone they trust to make healthcare decisions on their behalf should they become unable to do so themselves. Navigating through the complexities of healthcare can be daunting, and this form acts as a beacon, ensuring that personal healthcare preferences are honored. By design, it addresses a wide range of decisions—from routine medical care to life-sustaining treatments. This form not only empowers the appointed agent to act in the best interest of the person but also provides clarity and peace of mind to family members during stressful times. Understanding its importance, how to fill it out correctly, and the legal implications it carries are crucial steps in safeguarding one’s health and well-being.

Sample - Minnesota Medical Power of Attorney Form

This Medical Power of Attorney ("Document") is made in accordance with the Minnesota Health Care Directive Act and enables the Principal, whose details are stated below, to designate a Health Care Agent. The Agent will have the authority to make health care decisions for the Principal when the Principal is unable or chooses not to make health care decisions for themselves.

Principal's Information:

  • Name: ___________________________
  • Address: _________________________
  • City: ____________________________
  • State: Minnesota
  • Zip Code: ________________________
  • Date of Birth: ____________________
  • Social Security Number: ___________

Health Care Agent's Information:

  • Name: ___________________________
  • Address: _________________________
  • City: ____________________________
  • State: ___________________________
  • Zip Code: ________________________
  • Primary Phone Number: ____________
  • Alternate Phone Number: __________

In the event the above-named Health Care Agent is unable, unwilling, or ineligible to serve, the Principal appoints the following person as an alternate Health Care Agent:

Alternate Health Care Agent's Information:

  • Name: ___________________________
  • Address: _________________________
  • City: ____________________________
  • State: ___________________________
  • Zip Code: ________________________
  • Primary Phone Number: ____________
  • Alternate Phone Number: __________

The Agent's authority to make health care decisions for the Principal includes the following powers:

  1. To agree to, refuse, or withdraw consent to any type of medical care, including diagnostic, surgical, or therapeutic procedures.
  2. To have access to medical records and information to the same extent the Principal would have, including the right to disclose the records and information to others.
  3. To make decisions regarding the Principal’s residing in a long-term care facility, including assisted living or nursing home.
  4. To make decisions about the Principal’s participation in any medical research projects or clinical trials.
  5. To make decisions about the Principal’s end-of-life care, including decisions regarding withholding or withdrawal of life-sustaining treatment.

This Document does not authorize the Health Care Agent to make decisions about the Principal’s property or financial affairs. This Document will remain effective unless and until it is revoked by the Principal.

To be valid, this Document must be signed by the Principal in the presence of two witnesses or a notary public. The witnesses cannot be the Health Care Agent, the Principal’s health care provider, or employees at a health care facility where the Principal is receiving care.

By signing below, I acknowledge that I have read and understand this Medical Power of Attorney and affirm that I am granting my Health Care Agent the power to make health care decisions on my behalf as described herein.

Principal's Signature: ________________________ Date: _______________

Witnesses (or Notary)

  • Witness 1 Signature: ________________________ Date: _______________
  • Witness 1 Printed Name: _____________________
  • Witness 2 Signature: ________________________ Date: _______________
  • Witness 2 Printed Name: _____________________

OR

Notary Public

State of Minnesota

Notary Signature: ____________________________ Date: _______________

Commission expires: ___________________________

PDF Breakdown

Fact Description
Definition A Minnesota Medical Power of Attorney is a legal document that allows individuals to appoint someone else to make healthcare decisions on their behalf if they become incapacitated or unable to communicate their wishes.
Governing Laws The Minnesota Statutes, sections 145C.01 to 145C.23, also known as the Health Care Directive Act, govern Medical Power of Attorney forms in Minnesota.
Principal The individual who creates the Medical Power of Attorney, also known as the "principal," has the authority to decide who will be their healthcare agent to make decisions when they are not able to do so.
Healthcare Agent The appointed person or entity in the Medical Power of Attorney who is authorized to make healthcare decisions on behalf of the principal when they are incapacitated.
Eligibility To execute a Medical Power of Attorney in Minnesota, the principal must be an adult of sound mind at the time of creation.
Scope of Authority The healthcare agent's authority can range from general to specific medical decisions, as outlined by the principal in the Medical Power of Attorney document.
Revocation The principal retains the right to revoke or terminate the Medical Power of Attorney at any time, as long as they are capable of communicating their decision.

Guidelines on Writing Minnesota Medical Power of Attorney

When someone is faced with the decision to designate a medical power of attorney in Minnesota, it essentially means they are taking proactive steps to ensure their healthcare wishes are honored, especially during times when they might not be able to communicate those wishes themselves. It's an important and sometimes emotional process but knowing the steps to take can make it easier and ensure the desires are clearly outlined and respected.

The steps to complete the Minnesota Medical Power of Attorney form are as follows:

  1. Start by carefully reading the entire form to understand the scope and implications of assigning a medical power of attorney.
  2. Enter your full legal name at the top of the form to identify yourself as the principal—the person who is assigning the medical power of attorney.
  3. Choose a trusted individual to act as your agent—the person who will make healthcare decisions on your behalf if you are unable to do so. Fill in their full name, address, and contact details in the designated section.
  4. If desired, appoint an alternate agent by filling in their information. This step is optional but recommended, in case your primary agent is unavailable or unable to serve when needed.
  5. Detail the specific powers you are granting to your agent. This section allows you to specify what your agent can and cannot do in termsï of medical decision-making on your behalf.
  6. Discuss and consider limitations to your agent’s powers. If there are specific treatments or health care decisions you do not want your agent to make, clearly outline these restrictions in the form.
  7. Fill in any additional instructions or wishes regarding your health care that you want your agent and healthcare providers to follow. This might include preferences about life support, organ donation, pain management, and other important considerations.
  8. Sign and date the form in front of a notary public or two adult witnesses, as required by Minnesota law, to make the document legally binding. Be sure the witnesses also sign the form in the designated areas.
  9. Inform your agent, family, and possibly your primary care physician that you have completed a medical power of attorney form. Provide them with copies or let them know where they can find the document if needed.

After filling out the form, the next step is to safely keep the original document and distribute copies to the relevant parties. Communication is key; make sure the people who play significant roles in your healthcare and personal life are aware of your wishes and know who your chosen agent is. This proactive approach ensures that, in any situation where you might be unable to vocalize your healthcare preferences, your agent is prepared and legally equipped to make decisions that align with your stated desires.

Important Facts about Minnesota Medical Power of Attorney

What is a Medical Power of Attorney (MPOA) in Minnesota?

A Medical Power of Attorney in Minnesota is a legal document that allows an individual (the principal) to designate another person (the agent) to make health care decisions on their behalf if they are unable to do so themselves. This can include decisions about medical treatments, surgeries, and other health care services.

Who can serve as an agent under a Minnesota Medical Power of Attorney?

In Minnesota, an agent can be almost any adult who the principal trusts to make health care decisions for them. This often includes family members or close friends. However, there are some restrictions, such as the agent cannot be the principal's health care provider or an employee of the health care facility where the principal is receiving care, unless they are related to the principal.

How can someone create a Medical Power of Attorney in Minnesota?

Creating a Medical Power of Attorney in Minnesota involves filling out a form that clearly states the principal's wishes regarding medical treatment and designating an agent. The form must be signed by the principal and witnessed by two individuals who meet certain qualifications, or notarized. Minnesota may have specific forms or requirements, so it’s advised to consult legal resources or an attorney for guidance.

Is a Medical Power of Attorney the same as a Living Will?

No, a Medical Power of Attorney and a Living Will serve different purposes. A Living Will in Minnesota expresses an individual's wishes regarding end-of-life care, should they become unable to communicate those wishes themselves. In contrast, a Medical Power of Attorney appoints someone else to make health care decisions on behalf of the individual if they are incapacitated.

When does a Medical Power of Attorney become effective in Minnesota?

A Medical Power of Attorney in Minnesota becomes effective when the principal is unable to make their own health care decisions, as determined by their primary physician. The conditions or events that trigger this inability are typically outlined in the document itself.

Can a Medical Power of Attorney be revoked in Minnesota?

Yes, a Medical Power of Attorney can be revoked at any time by the principal as long as they are mentally competent. This revocation can be done in writing or simply by informing the health care provider or the agent orally.

Does the agent in a Minnesota Medical Power of Attorney have the authority to make any medical decision?

The agent's authority in a Minnesota Medical Power of Attorney can be as broad or as limited as the principal specifies in the document. However, there are certain decisions that the agent may not be allowed to make, such as refusing basic care necessary for the comfort of the principal.

Is a Minnesota Medical Power of Attorney valid in other states?

While many states have laws recognizing medical power of attorney documents executed in other states, the specifics can vary. It's important for individuals to check the laws of any state where they might receive medical care to ensure their Minnesota Medical Power of Attorney will be honored.

What happens if there is no Medical Power of Attorney in place in Minnesota?

If an individual in Minnesota becomes incapacitated without a Medical Power of Attorney in place, health care decisions may be made by a court-appointed guardian or, depending on state law, by default to certain relatives in a prioritized order. This process can be time-consuming and may not reflect the individual's wishes.

Can a Minnesota Medical Power of Attorney include instructions for organ donation?

Yes, an individual can include their wishes regarding organ donation within their Medical Power of Attorney document in Minnesota. This can ensure their desires are known and can be acted upon by their designated agent at the appropriate time.

Common mistakes

When preparing a Minnesota Medical Power of Attorney (POA) form, precision is paramount. This document allows an individual, known as the principal, to designate another person, named the agent, to make healthcare decisions on their behalf should they become incapacitated. Missteps in completing this form can lead to unnecessary legal complications and delays during critical times. Here are ten common mistakes people often make:

  1. Not following state-specific requirements: Each state has its own set of rules for creating a valid Medical Power of Attorney. Failure to adhere to Minnesota's specific statutes regarding format, necessary clauses, or witnessing can invalidate the entire document.
  2. Choosing an inappropriate agent: The agent must be someone who is not only trusted but also capable of making challenging decisions under pressure. Designating an agent who lives far away or who may not be up to the task can hinder decision-making processes when time is of the essence.
  3. Using vague language: Ambiguity in expressing the principal's healthcare wishes can create confusion. It's essential to use clear and precise language to outline specific powers granted to the agent and any limitations on those powers.
  4. Omitting alternative agents: Failing to designate an alternate agent can become problematic if the primary agent is unable or unwilling to serve. It's prudent to have a backup to ensure that the principal's healthcare decisions are managed without interruption.
  5. Ignoring the need for witnesses or a notary public: Skipping the step of properly witnessing or notarizing the document, as required by Minnesota law, can result in the Medical Power of Attorney being considered invalid.
  6. Overlooking the inclusion of specific healthcare directives: While general powers are covered, adding specific instructions for treatment preferences in certain situations, such as end-of-life care or emergency medical situations, ensures that the principal’s wishes are honored.
  7. Forgetting to communicate with the chosen agent: Not discussing the powers and responsibilities with the chosen agent ahead of time can lead to misunderstandings or reluctance from the agent to accept their role when needed.
  8. Lack of a defined expiration date: Without setting an expiration date or event that ends the power of attorney, the document remains in effect indefinitely, which might not always be the principal's intention.
  9. Not keeping the document accessible: A Medical Power of Attorney is of no use if it cannot be found or accessed quickly in an emergency. It's crucial to store the document in a secure yet accessible place and let the agent know where it is.
  10. Failing to review and update the document: Life changes, such as relocation, a change in marital status, or changes in health condition, can affect the relevance and effectiveness of the POA. Regularly reviewing and updating the document as necessary ensures that it accurately reflects the principal's current wishes.

Avoiding these mistakes requires careful consideration, clear communication, and adherence to legal requirements. By taking these steps, individuals can ensure that their healthcare decisions are in reliable hands, even when they cannot make those decisions themselves.

Documents used along the form

When a person decides to fill out a Minnesota Medical Power of Attorney form, it's a step towards ensuring that their healthcare decisions are in trusted hands should they become unable to make those decisions themselves. However, this crucial document is often just one part of a comprehensive plan for one's health and well-being. To fully convey one's wishes about healthcare, end-of-life care, and the handling of their affairs after death, several other documents might also be prepared alongside the Medical Power of Attorney. Each of these documents serves its unique purpose and complements the information laid out in the Medical Power of Attorney.

  • Advance Healthcare Directive: This documents one's specific wishes about the types of medical treatments and life-sustaining measures they want or do not want if they're unable to make those decisions themselves, such as resuscitation or tube feeding.
  • HIPAA Authorization Form: Enables healthcare providers to disclose one's personal health information to designated individuals, not just the agent named in a Medical Power of Attorney. This ensures loved ones or concerned parties can access important health information when necessary.
  • Living Will: Often included within an Advance Healthcare Directive, it specifically outlines whether or not one wishes to receive life-prolonging medical treatments in the event they are terminally ill or permanently unconscious.
  • Last Will and Testament: Details how one's assets and estate should be distributed after death. Though not a healthcare document, it's a critical component of comprehensive planning, outlining the distribution of assets, guardianship decisions, and other final wishes.
  • Do Not Resuscitate (DNR) Order: A medical order signed by a physician, instructing healthcare providers not to perform CPR if one's breathing stops or if the heart stops beating. This document must usually be completed and signed in a medical setting.
  • Durable Power of Attorney for Finances: Appoints someone to make financial decisions on one’s behalf, ensuring that bills, taxes, and financial matters are handled if one is incapacitated.
  • Declaration for Mental Health Treatment: Specifies one’s preferences for mental health treatment, including medications, counseling, and hospitalization preferences, in case they are unable to make these decisions in the future.

While the Minnesota Medical Power of Attorney focuses on appointing someone to make healthcare decisions, the documents mentioned above cover a broader spectrum of personal, healthcare, and financial decisions. Together, they create a complete plan that addresses various scenarios, ensuring that one’s wishes are understood and respected. Individuals are encouraged to consult with legal and healthcare professionals when drafting these documents to ensure they accurately reflect their wishes and comply with current Minnesota laws.

Similar forms

The Minnesota Medical Power of Attorney (MPOA) form is akin to the Health Care Directive, as both documents serve the purpose of outlining an individual's preferences for medical treatment and appointing someone to make health care decisions on their behalf if they are unable to do so. The critical similarity lies in their function of empowering a trusted person to speak for the patient regarding medical care, ensuring that the person's medical wishes are followed even when they cannot communicate them directly.

Comparable to the MPOA is the Durable Power of Attorney for Health Care, which, like the MPOA, specifically addresses decisions about health care and end-of-life care. The durability aspect means that the document remains in effect even if the person becomes incapacitated, a significant feature that it shares with the MPOA. The focus on health care decisions sets both documents apart from broader power of attorney documents that may cover financial or legal matters.

Similarly, the Living Will is closely related to the MPOA. While a Living Will typically outlines specific wishes regarding end-of-life care, such as life support and pain management, the MPOA appoints someone to make decisions that are in line with those wishes. The two documents often work in tandem to ensure that the patient's preferences are both documented and actionable, through the authority granted to the designated agent in the MPOA.

The Advance Directive is another document that shares similarities with the MPOA. It is an umbrella term that can include both a Living Will and a Medical Power of Attorney. This comprehensive approach ensures that a person's healthcare wishes are respected by both documenting specific treatment preferences and naming someone to make healthcare decisions, echoing the dual functionality found in the MPOA.

The HIPAA Release Form also intersects with the MPOA in its ability to ensure a person's medical wishes are honored. By allowing designated individuals access to the person's health information, it complements the MPOA. This access is crucial for the person named in the MPOA to make informed decisions about the patient's healthcare, underscoring the interconnectedness of information sharing and decision-making authority in medical care.

Comparable in its objective, the Do Not Resuscitate (DNR) Order is a specific medical order that tells health care providers not to perform CPR if the patient's breathing stops or if the heart stops beating. While a DNR is more specific in scope, focusing solely on CPR and not other forms of medical intervention, it similarly reflects a patient's healthcare preferences for critical situations. When combined with an MPOA, it ensures that the healthcare agent's decisions are informed by the patient's specific wishes regarding life-saving measures.

The Financial Power of Attorney, while distinctly different in its focus on financial matters, shares the underlying principle of designating another person to make decisions on one’s behalf. Just as the MPOA allows an agent to make healthcare decisions, a Financial Power of Attorney grants someone the authority to handle financial affairs. This parallel highlights the importance of preparedness and trust in both health care and financial planning, acknowledging the significance of comprehensive planning across different aspects of one’s life.

Lastly, the Mental Health Advance Directive, similar to the MPOA, focuses specifically on decisions related to mental health care. It allows individuals to express their wishes regarding mental health treatment and choose someone to decide on their behalf if they're unable to do so. This specificity towards mental health aligns closely with the MPOA's broader aim of ensuring a person’s healthcare preferences are respected and followed, offering a tailored approach to a critical aspect of healthcare decision-making.

Dos and Don'ts

When filling out the Minnesota Medical Power of Attorney form, it’s crucial to follow guidelines that protect your interests and ensure your wishes are legally respected. Here are the things you should and shouldn't do:

Do:

  1. Read instructions carefully before you begin to understand the form’s requirements.

  2. Choose a trusted individual as your agent who will act in your best interest.

  3. Provide clear and specific instructions for your medical care preferences.

  4. Discuss your wishes with the agent you’ve chosen to ensure they understand your preferences.

  5. Sign and date the form in the presence of a notary public or required witnesses to ensure its legal validity.

  6. Keep the original document in a safe but accessible place and inform your agent about where it's stored.

  7. Provide copies to your agent, family members, and healthcare providers to make them aware of your wishes.

  8. Review and update your Medical Power of Attorney periodically, especially after any significant life changes.

Don’t:

  • Rush when choosing your agent; consider their ability and willingness to act on your behalf.

  • Leave any sections incomplete; an incomplete form may lead to confusion or be considered invalid.

  • Forget to update your form after life changes such as marriage, divorce, the birth of a child, or a change in health.

  • Assume your healthcare providers are automatically aware of your Medical Power of Attorney; always provide them with a copy.

Misconceptions

When it comes to the Minnesota Medical Power of Attorney (MPOA) form, several misconceptions can lead to confusion and misunderstanding. It's essential to clarify these misconceptions to ensure that individuals are well-informed about the implications and functionalities of the MPOA.

  • A Medical Power of Attorney and a Living Will are the same. Unlike a Living Will, which outlines an individual's wishes regarding end-of-life care, a Medical Power of Attorney names someone to make healthcare decisions on behalf of the individual if they are unable to do so.
  • Once appointed, the Medical Power of Attorney cannot be changed. The person who creates an MPOA can revoke or amend it at any time as long as they are mentally competent.
  • The person appointed as Medical Power of Attorney can make decisions immediately. The appointed agent can only make healthcare decisions if the individual is unable to make their own decisions, as determined by a medical professional.
  • You can only appoint a family member as your Medical Power of Attorney. While many choose family members, any trusted adult, such as a close friend, can be appointed.
  • A lawyer is needed to set up a Medical Power of Attorney. While legal advice can be beneficial, especially in complicated situations, individuals can complete the form themselves by filling in the required information and ensuring it meets Minnesota's legal requirements, such as witness or notarization provisions.
  • The appointed agent can make financial decisions. The MPOA only grants authority to make healthcare decisions. A separate document, called a Financial Power of Attorney, is needed for financial matters.
  • If you're married, your spouse automatically becomes your Medical Power of Attorney. Without a legally executed MPOA naming the spouse as the agent, they do not automatically assume this role.
  • A Medical Power of Attorney is only for the elderly or terminally ill. Individuals of any age can face situations where they are unable to make healthcare decisions for themselves, making an MPOA important for adults of all ages.
  • The document takes effect outside of Minnesota. While many states have reciprocal laws respecting out-of-state MPOAs, it's not guaranteed. One should verify how another state would recognize a Minnesota MPOA.
  • Completing a Medical Power of Attorney means losing control over your healthcare decisions. As long as individuals are capable of making their own decisions, their autonomous healthcare decisions take precedence over the agent's decisions.

Key takeaways

Filling out a Minnesota Medical Power of Attorney form is an important step in ensuring your healthcare wishes are followed if you're unable to make decisions for yourself. Here are some key takeaways to consider:

  • Choosing the right agent is crucial. Make sure the person you select is trustworthy and understands your healthcare wishes. This person will have the authority to make medical decisions on your behalf.
  • Be specific about your healthcare preferences. The more details you provide in the document, the better your agent will be able to follow your wishes.
  • The form must be signed in the presence of a notary public or two witnesses to be legally binding. These witnesses cannot be the agent you've chosen or your healthcare providers.
  • Once the form is completed and signed, make sure your agent, family members, and healthcare providers have copies. This ensures that your agent can act on your behalf when necessary.
Please rate Attorney-Verified Minnesota Medical Power of Attorney Form Form
4.75
Excellent
183 Votes