Medical Power of Attorney
Homepage ➣ Attorney-Verified New Hampshire Medical Power of Attorney Form
Outline

When individuals think about planning for the future, a crucial component often considered is how medical decisions should be handled in the event they're unable to make those decisions for themselves. This is where the New Hampshire Medical Power of Attorney (MPOA) form becomes paramount. Serving as a legal document, it empowers another person, known as a health care agent, to make medical decisions on behalf of the individual if they become incapacitated or otherwise unable to communicate their wishes. The scope of the MPOA includes, but is not limited to, treatment options, the hiring or firing of medical personnel, and decisions about life support. It's designed to ensure that the individual’s health care preferences are honored, providing peace of mind to both the person and their loved ones. The process of executing a Medical Power of Attorney requires careful consideration and understanding of its components, such as choosing an agent who is trusted, specifying wishes regarding treatment preferences, and understanding the legal requirements for it to be considered valid in New Hampshire. This form is a key element in comprehensive health care planning, ensuring that every individual's medical care aligns with their values and wishes, even when they cannot speak for themselves.

Sample - New Hampshire Medical Power of Attorney Form

New Hampshire Medical Power of Attorney

This Medical Power of Attorney is established in accordance with the New Hampshire Advance Directives Act (RSA 137-J) and allows you to designate a trusted individual to make healthcare decisions on your behalf should you become unable to do so yourself.

Principal Information

Full Name: ___________________________________________________

Date of Birth: ________________________

Address: _____________________________________________________

City: _________________________ State: NH Zip Code: ___________

Agent (Healthcare Proxy) Information

Full Name: ___________________________________________________

Relationship to Principal: ____________________________________

Primary Phone: ___________________ Alternate Phone: ___________

Email Address: _______________________________________________

Address: _____________________________________________________

City: _________________________ State: __ Zip Code: ___________

By signing this document, I hereby give the named agent the power to make health care decisions on my behalf. This includes the power to consent to, refuse, or withdraw consent for medical treatment when I am unable to make these decisions myself.

Alternate Agent Information (Optional)

Should the initially designated agent be unable, unwilling, or unavailable to act, I designate the following individual as my alternate agent:

Full Name: ___________________________________________________

Relationship to Principal: ____________________________________

Primary Phone: ___________________ Alternate Phone: ___________

Email Address: _______________________________________________

Address: _____________________________________________________

City: _________________________ State: __ Zip Code: ___________

Scope of Agent's Authority

The agent's authority to make medical decisions on my behalf includes, but is not limited to, the following:

  • Deciding on starting, continuing, or stopping medical treatments, including life-sustaining treatments.
  • Accessing my medical records necessary for informed decision-making.
  • Deciding on mental health treatments, where permitted by law.
  • Making decisions about organ donation, autopsy, and final disposition of my body.

This authority does not include the power to consent to voluntary inpatient mental health services, to consent to sterilization, or to terminate life support in non-terminal conditions without clear and convincing evidence of my wishes.

Signatures

This document must be signed in the presence of two witnesses, who cannot be the healthcare agent, the alternate, a spouse, or a relative. Alternatively, this document can be notarized.

Principal's Signature: _______________________________ Date: ____________

Agent's Signature: _______________________________ Date: ____________

Alternate Agent's Signature (If Applicable): _______________________________ Date: ____________

Witnesses

  1. Name: ____________________________________ Signature: _______________________________ Date: ____________
  2. Name: ____________________________________ Signature: _______________________________ Date: ____________

Notarization (If Applicable)

This section is to be completed by a Notary Public if notarization is chosen as the method of validation.

State of New Hampshire )

County of ___________ )

On this ____ day of ___________, 20__, before me, a Notary Public, personally appeared the above-named principal who acknowledged signing this document as their free act and deed.

Notary Public's Signature: _________________________________

My Commission Expires: ______________

⇓ Medical Power of Attorney PDF

PDF Breakdown

Fact Number Description
1 The New Hampshire Medical Power of Attorney form allows individuals to appoint someone to make healthcare decisions on their behalf if they become unable to do so themselves.
2 It is governed by the New Hampshire Revised Statutes Annotated (RSA) 137-J, specifically the law regarding Durable Power of Attorney for Health Care.
3 The appointed agent can make decisions on behalf of the principal regarding medical treatment, including the refusal of treatment, based on the principal's wishes.
4 The form requires the principal to provide full details about the appointed agent, including contact information, to ensure clear communication channels with healthcare professionals.
5 For the document to be valid, it must be signed in the presence of two adult witnesses, neither of whom is the health care agent, and notarized in New Hampshire.
6 The principal has the authority to specify limitations on the agent's decision-making powers, tailoring the agent's authority to align with the principal's personal values and preferences.
7 In the absence of a Medical Power of Attorney, decisions will be made by a legal guardian or next of kin, according to a statutory hierarchy, which may not reflect the individual's personal wishes.
8 The form encourages the principal to discuss their wishes with their appointed agent, family members, and healthcare providers to ensure decisions are made in accordance with the principal's values.
9 The Medical Power of Attorney remains in effect indefinitely unless a specific expiration date is mentioned or the principal revokes the document.
10 A separate document, often a living will or advance directive, is recommended to be completed along with the Medical Power of Attorney for a comprehensive approach to future healthcare planning.

Guidelines on Writing New Hampshire Medical Power of Attorney

When the time comes to make important healthcare decisions, having a Medical Power of Attorney (MPOA) in place ensures your wishes are heard and respected. This legal document grants a person you trust the authority to make health care decisions on your behalf if you're unable to do so. Filling out an MPOA form in New Hampshire is a straightforward process, but it’s crucial to pay close attention to detail to ensure that the document accurately reflects your desires. Below are the steps to properly fill out the New Hampshire Medical Power of Attorney form.

  1. Begin by obtaining the latest version of the New Hampshire Medical Power of Attorney form. Ensure it’s the correct document for New Hampshire, as requirements can vary by state.
  2. Fill in your full legal name and address at the top of the form to clearly identify yourself as the principal—the person making the document.
  3. Select your agent—the person you trust to make healthcare decisions on your behalf. Write their full name, relationship to you, address, and contact information. It’s important to choose someone who understands your wishes and is willing to advocate on your behalf.
  4. If desired, appoint an alternate agent. This step is optional but recommended in case your primary agent is unable to perform their duties. Include the same information for your alternate agent as you did for your primary agent.
  5. Specify the powers you are granting to your agent. While the form may have standard language, you can add instructions or limitations to tailor it to your wishes. Be as detailed as necessary to ensure your healthcare preferences are understood.
  6. Address any specific healthcare wishes you have, such as life-sustaining treatment preferences, organ donation, and final arrangements. This section is your opportunity to communicate your healthcare values and choices.
  7. Review the special conditions and limitations section to ensure it aligns with your intentions. Amend or add any additional instructions to clarify your specific desires regarding your healthcare.
  8. Sign and date the form in the presence of two witnesses who are not your healthcare provider, not related to you by blood, marriage, or adoption, and who do not stand to inherit from you. New Hampshire law may require the witnesses to meet specific criteria, so paying close attention to these details is crucial.
  9. In some cases, notarization may be required or recommended to add an extra layer of legal protection. If you choose to notarize the document, ensure this is done according to New Hampshire laws.
  10. Once completed, provide copies of the signed form to your healthcare agent, alternate agent (if appointed), primary care physician, and any healthcare facilities that are currently providing you care. It’s also wise to discuss your wishes and any specific instructions detailed in the document with your appointed agent(s).

After completing these steps, your New Hampshire Medical Power of Attorney will be in effect. It's a powerful tool that speaks for you when you can't speak for yourself, ensuring your healthcare decisions are in trusted hands. Remember to review and update the document as needed, especially after any significant life changes or changes in your health care preferences. Keeping your MPOA current is as important as creating it, ensuring that your healthcare wishes are always accurately represented and can be legally upheld.

Important Facts about New Hampshire Medical Power of Attorney

What is a Medical Power of Attorney in New Hampshire?

A Medical Power of Attorney in New Hampshire is a legal document that allows you to appoint someone else, known as an agent, to make healthcare decisions on your behalf if you become incapacitated and unable to make those decisions yourself. This document is crucial for ensuring your medical preferences are respected when you can't express them.

Who can be appointed as an agent in New Hampshire?

In New Hampshire, an agent must be a competent adult. While most people choose a close family member or a friend as their agent, it's essential to select someone who thoroughly understands your healthcare preferences and is willing to advocate on your behalf. Professionals directly involved in your healthcare, unless they are related to you, generally cannot serve as your agent.

How do I create a Medical Power of Attorney in New Hampshire?

To create a Medical Power of Attorney in New Hampshire, you must fill out the appropriate form, which includes detailing your healthcare preferences and appointing an agent. It is imperative that this form adheres to New Hampshire's legal requirements, including being signed in the presence of two witnesses or a notary public. Consulting with a lawyer can ensure the document is properly executed.

When does a Medical Power of Attorney become effective in New Hampshire?

A Medical Power of Attorney becomes effective in New Hampshire as soon as it is signed and executed according to state laws. However, your agent will only begin making decisions on your behalf if a doctor determines that you are incapable of making healthcare decisions for yourself.

Can I change or revoke my Medical Power of Attorney?

Yes, you have the right to change or revoke your Medical Power of Attorney at any time, as long as you are of sound mind. To do so, you should inform your healthcare provider, your agent, and any other significant parties in writing. Creating a new Medical Power of Attorney can also automatically revoke the previous one.

What happens if I don't have a Medical Power of Attorney in New Hampshire?

If you don't have a Medical Power of Attorney and become unable to make healthcare decisions, New Hampshire law will dictate who gets to make those decisions on your behalf. Typically, this responsibility falls to close family members, in a priority order starting with your spouse, then adult children, parents, and so on. However, this default may not align with your preferences, highlighting the importance of having a Medical Power of Attorney in place.

Is a Medical Power of Attorney different from a Living Will in New Hampshire?

Yes, a Medical Power of Attorney and a Living Will serve different purposes in New Hampshire. A Medical Power of Attorney focuses on appointing someone to make healthcare decisions on your behalf, while a Living Will allows you to express your wishes regarding end-of-life care. Although distinct, both documents are essential components of a comprehensive healthcare directive plan.

Common mistakes

When individuals step into the role of preparing a New Hampshire Medical Power of Attorney form, the tasks they face seem straightforward. However, amidst the simplicity, critical errors often emerge, undermining the efficacy and intent behind their actions. By delineating these common mistakes, there's a golden opportunity to not only rectify but also prevent their recurrence, ensuring that the form serves its purpose as a sturdy, legal beacon during times of medical uncertainty.

  1. Not specifying the powers clearly. Individuals sometimes leave the powers of the agent too vague or, conversely, too restrictive without considering the breadth of decisions the agent may need to make. This lack of clarity can create confusion and potentially hinder the agent's ability to act in the best interest of the principal when faced with unexpected medical situations.

  2. Failing to choose an alternate agent. In many instances, the importance of naming an alternate agent is underestimated. Should the primary agent be unable or unwilling to serve, the absence of a secondary choice can lead to delays in medical decision-making or necessitate judicial intervention.

  3. Not discussing wishes with the chosen agent. A significant oversight is neglecting to have a comprehensive discussion with the chosen agent about the principal's values, beliefs, and specific health care wishes. This detailed conversation is essential for preparing the agent to make decisions that align closely with the principal’s desires.

  4. Omit-window-using proper witnesses and/or a notary. New Hampshire law may require your Medical Power of Attorney to be witnessed or notarized to ensure its validity. Overlooking this step can render the document legally ineffective, creating barriers during critical moments when the document needs to be operational.

  5. Succumbing to pressure. Individuals sometimes fill out the form under the pressure of family members or others without fully considering their own wishes or the suitability of the appointed agent. This mistake can lead to the selection of an agent who may not act in the principal's best interest or according to their preferences.

  6. Forgetting to update the document. Life changes such as a shift in relationship dynamics, relocation, or changes in health status necessitate updates to the Medical Power of Attorney. Failure to keep the document current can lead to complications and discrepancies that could have been avoided.

  7. Incorrectly believing one form fits all. Sometimes, there's a misconception that a single Medical Power of Attorney form is suitable for all states. However, each state has specific laws and requirements. Using a generic form without ensuring it meets New Hampshire's legal criteria can invalidate the document.

  8. Not properly distributing copies of the document. Once completed, it's crucial to distribute copies of the Medical Power of Attorney to relevant parties, including health care providers, the appointed agent, and close family members. Neglecting this step can delay medical decisions as those needing to act on the principal's behalf may not have access to the document when necessary.

By steering clear of these pitfalls, individuals can forge a Medical Power of Attorney that stands as a robust testament to their wishes, ensuring that their health care decisions rest in trusted hands during the most vulnerable moments. This dedication to precision and foresight fortifies the principal's autonomy and the dignity of their health care journey.

Documents used along the form

When preparing for the possibility of being unable to make medical decisions, it's crucial to consider all the legal documents that can support your wishes alongside the New Hampshire Medical Power of Attorney (MPOA) form. The MPOA is a key document that allows you to designate someone you trust to make health care decisions on your behalf if you're unable to do so. However, to ensure a comprehensive approach to health care planning, several other forms and documents are often used in conjunction with the MPOA. Understanding these documents can provide a robust framework for conveying your health care preferences.

  • Advance Directive: This is a broader document that typically includes the Medical Power of Attorney along with a Living Will. While the MPOA appoints a health care agent, the Living Will part of an Advance Directive outlines specific medical treatments you do or do not want to be used to keep you alive, as well as other decisions like pain management or organ donation. Together, they guide your health care representative and doctors about your preferences.
  • HIPAA Authorization Form: The Health Insurance Portability and Accountability Act (HIPAA) protects the privacy of one's health information. A HIPAA Authorization Form allows your health care providers to disclose your health information to the person you've designated as your health care agent under your MPOA. This is crucial for enabling your agent to make informed decisions about your health care.
  • Do Not Resuscitate (DNR) Order: A DNR is a medical order that tells health care professionals not to perform CPR if your breathing stops or if your heart stops beating. It’s different from the Living Will because it is a medical order, whereas a Living Will is a legal document. A DNR is important if you have strong feelings about not wanting to be resuscitated under certain circumstances.
  • POLST Form (Physician Orders for Life-Sustaining Treatment): For individuals with serious illness or frailty, a POLST form provides medical orders regarding treatments they want or do not want to receive. Unlike an Advance Directive that provides general wishes, the POLST form gives specific medical orders to be followed by health care workers during a medical emergency.

Together, these documents ensure that your health care preferences are respected and clearly communicated to both your chosen representative and your medical providers. While the MPOA designates who will speak for you, the accompanying forms like the Advance Directive, HIPAA Authorization, DNR Order, and POLST form dictate what your health care wishes are, covering a host of different scenarios. It's advisable to discuss these documents with a legal professional to ensure that they are correctly set up and legally binding, suitably reflecting your health care directives. Ensuring that these documents are in order can provide peace of mind to you and your loved ones.

Similar forms

A Living Will is closely related to a New Hampshire Medical Power of Attorney. While the latter designates an individual to make healthcare decisions on someone's behalf, a Living Will specifically outlines a person’s preferences regarding medical treatment in scenarios where they are unable to communicate these wishes themselves. Both documents play crucial roles in healthcare planning, ensuring that a person's healthcare choices are respected even when they can't vocalize them.

Healthcare Proxy forms are similar to Medical Power of Attorney documents in that they both allow another person to make medical decisions on someone's behalf. The key difference often lies in the terminology and scope defined within different states or jurisdictions. A Healthcare Proxy may specifically relate to the appointment of the decision-making agent, while a Medical Power of Attorney can encompass broader healthcare directives and preferences.

The Durable Power of Attorney for Health Care shares similarities with the New Hampshire Medical Power of Attorney by also appointing someone to make healthcare decisions. The durability aspect ensures that the designated agent's power remains effective even when the principal becomes incapacitated, underlining the significance of continuity in decision-making ability for health-related matters.

An Advance Directive is an overarching term that can include elements of a Medical Power of Attorney and a Living Will. It details a person's healthcare preferences and appoints a healthcare agent to enforce these choices. The similarity lies in their fundamental purpose to guide healthcare decisions according to the individual's wishes, highlighting the importance of proactive health care planning.

A Medical Directive, often part of broader Advance Directives, conveys specific instructions about medical treatment preferences. It shares similarities with Medical Power of Attorney documents in the sense of addressing healthcare decisions but is more focused on detailing specific treatments a person does or does not want, rather than appointing a decision maker.

The Power of Attorney for Child Care is akin to a Medical Power of Attorney but is focused specifically on minors. It grants an adult authority to make health care (and often educational and welfare) decisions for a child when parents are unable to do so. This similarity underscores the adaptability of power of attorney documents to suit various caregiving situations.

A General Durable Power of Attorney, while broader in scope, shares the element of durability with a Medical Power of Attorney, meaning it remains in effect even if the person becomes incapacitated. However, it extends beyond healthcare decisions to include financial and legal decisions, indicating the broad applicability of durable powers of attorney in life planning.

A Mental Health Care Power of Attorney focuses specifically on decisions related to mental health care, which can be a component of a broader Medical Power of Attorney. It emphasizes the need for sensitive and informed decision-making in mental health treatments, reflecting the importance of addressing all aspects of a person’s health in planning documents.

Finally, a HIPAA Release Form, while not a power of attorney, complements a Medical Power of Attorney by granting designated individuals access to the person's protected health information. This access enables informed decision-making about the individual's health care and ensures that agents have the information needed to advocate effectively on the person’s behalf.

Dos and Don'ts

When it comes to establishing a Medical Power of Attorney (MPOA) in New Hampshire, it's important to approach the document with care and consideration. An MPOA enables you to appoint someone to make health care decisions on your behalf should you be unable to do so. Below are crucial dos and don'ts for completing this vital form.

Do:

  • Read carefully: Take the time to thoroughly read and understand the form before filling it out. This ensures you know exactly what powers and limitations you are granting.
  • Choose wisely: Select a trusted individual who understands your healthcare wishes and is willing to act on your behalf. This person should be someone you trust implicitly with your health care decisions.
  • Be specific: When possible, be clear about your medical treatment preferences. This could include directions about life support, pain management, and other critical care decisions.
  • Consult a professional: If you have questions or uncertainties, consider consulting a legal professional. They can offer guidance tailored to your situation.
  • Witnesses and notarization: Ensure your form is properly witnessed and notarized if required. This step is crucial for the document to be legally binding.
  • Inform others: Communicate with your family, close friends, and healthcare providers about the existence of your MPOA and who you have appointed as your agent.

Don't:

  • Rush the process: Avoid filling out the form in a hurry. Take your time to consider all options and implications of your choices.
  • Use vague language: Ambiguity can lead to confusion and potentially conflict. Strive for clarity in expressing your healthcare preferences and instructions.
  • Forget to update: Life changes such as a divorce, the death of the appointed agent, or a change in your health condition can affect your MPOA. Review and update it as necessary.
  • Omit discussions: Failing to discuss your wishes and the contents of your MPOA with your appointed agent and family can lead to misunderstandings down the line.
  • Dismiss state requirements: Each state can have different legal requirements for an MPOA. Neglecting New Hampshire's specific provisions could render the document invalid.
  • Assume it's immediately active: Understand when your MPOA comes into effect. Some are only activated under certain conditions, such as when you are deemed unable to make decisions for yourself.

Misconceptions

When considering the creation of a Medical Power of Attorney (MPOA) in New Hampshire, individuals may encounter several misconceptions that can lead to confusion about its purpose and function. Understanding these misconceptions is crucial for making informed decisions regarding healthcare planning. Here are six common misunderstandings:

  • Misconception 1: Only the elderly need a Medical Power of Attorney.
    People of any age can face situations where they are unable to make their own medical decisions due to accidents or sudden illness. A Medical Power of Attorney is a prudent step for adults of all ages.
  • Misconception 2: A Medical Power of Attorney covers financial decisions.
    The MPOA is strictly limited to healthcare decisions. Financial matters require a separate legal document known as a Financial Power of Attorney.
  • Misconception 3: Once appointed, the agent's decisions are final.
    The person creating the MPOA can specify conditions or limit the powers of their agent, and they have the right to revoke or amend the document as long as they are competent.
  • Misconception 4: My medical treatment preferences do not need to be communicated to my healthcare agent.
    It is essential to discuss healthcare preferences and specific wishes with the chosen agent to ensure they make decisions that align with the principal's values and desires.
  • Misconception 5: A Medical Power of Attorney is valid in all states.
    While many states have laws recognizing Medical Power of Attorney documents from other states, it is advisable to create a separate document if you spend a lot of time in another state or move to ensure compliance with local laws.
  • Misconception 6: The chosen healthcare agent can also serve as one of the two required witnesses.
    New Hampshire law requires that the MPOA be witnessed by two individuals who are not the appointed healthcare agent, to ensure impartiality and lessen conflicts of interest.

Clearing up these misconceptions allows individuals to approach healthcare planning with a better understanding and confidence. It’s advisable to consult with a legal professional to ensure that a Medical Power of Attorney accurately reflects one’s wishes and complies with New Hampshire laws.

Key takeaways

Filling out and using a Medical Power of Attorney (MPOA) form in New Hampshire is a crucial step for individuals planning for their future health care decisions. Understanding how to properly complete and utilize this document can ensure your medical wishes are honored if you're unable to communicate them yourself. Here are key takeaways about this process:

  • It's essential to select a trusted individual as your agent. This person will have the authority to make health care decisions on your behalf in case you're incapacitated.
  • The form must be completed with accurate and clear information to effectively convey your medical treatment preferences.
  • New Hampshire law requires the MPOA to be signed in the presence of two witness signatures or a notary public to be legally binding.
  • Discussing your health care wishes and any specific medical treatments you desire or wish to avoid with your chosen agent is crucial. This conversation ensures they make decisions aligned with your values and preferences.
  • You have the right to revoke or change your MPOA at any time, as long as you are competent. This must be done in writing and communicated to your health care provider and your agent.
  • It's advisable to review and possibly update your MPOA periodically, especially after significant life changes such as a marriage, divorce, or the diagnosis of a serious illness.
  • Make copies of the signed MPOA. Provide one to your health care agent, primary care physician, and possibly a close family member or friend. You might also consider keeping a digital copy accessible.
  • Be aware that your MPOA does not take effect until your doctor determines you are unable to make your own medical decisions. Until such determination, you retain the right to make your own health care decisions.

By taking these steps, you can ensure that your health care wishes are known and can be acted upon, providing peace of mind for you and your loved ones.

Please rate Attorney-Verified New Hampshire Medical Power of Attorney Form Form
4.75
Excellent
205 Votes

Fill out Other Medical Power of Attorney Forms for Different States

Medical Power of Attorney New Mexico Pdf - A Medical Power of Attorney remains in effect until you revoke it, even if you recover from incapacity.

Wisconsin Power of Attorney Requirements - This legal document can be revoked or amended at any time, provided you are of sound mind to do so.

Missouri Health Care Power of Attorney - Relieve loved ones of making tough decisions by designating a Medical Power of Attorney now.