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In Georgia, the Medical Power of Attorney form serves as a crucial legal document that empowers individuals to designate someone they trust to make healthcare decisions on their behalf in the event they become unable to do so. This form not only outlines the specific powers granted to the appointed agent but also ensures that the individual's healthcare preferences are respected. Key components include the identification of the principal and agent, the scope of authority, and any specific instructions regarding medical treatment. Importantly, the form can accommodate various preferences, allowing individuals to express their wishes about life-sustaining treatments, organ donation, and other critical health decisions. Understanding how to properly complete and execute this document is essential, as it helps safeguard one’s health choices during vulnerable times. By taking the time to establish a Medical Power of Attorney, individuals can alleviate potential stress for their loved ones and ensure that their medical care aligns with their values and desires.

Georgia Medical Power of Attorney Example

Georgia Medical Power of Attorney

This Georgia Medical Power of Attorney is a legal document that allows an individual (the "Principal") to designate another person (the "Agent") to make healthcare decisions on their behalf, should they become unable to do so. This document is crafted in compliance with the Georgia Advance Directive for Health Care Act.

Principal Information

Name: _______________________________________________

Address: _____________________________________________

City, State, ZIP: ______________________________________

Phone Number: ________________________________________

Email Address: ________________________________________

Agent Information

Name: _______________________________________________

Address: _____________________________________________

City, State, ZIP: ______________________________________

Phone Number: ________________________________________

Email Address: ________________________________________

By this document, I, the Principal, appoint the above-named Agent to act on my behalf regarding decisions directly related to my health care in the event that I, according to my primary health care provider, am unable to make these decisions myself.

The Agent's authority includes, but is not limited to, the following decisions:

  • Consenting to, refusing, or withdrawing consent for any and all types of medical care, including surgical procedures and artificial nutrition and hydration.
  • Accessing medical records and information to the extent necessary to make informed decisions about treatment.
  • Deciding on the disposition of remains after death, subject to any limitations I have set forth in this document or elsewhere.

This Medical Power of Attorney does not authorize the Agent to make financial or other non-medical decisions for the Principal.

This document shall remain in effect until revoked by the Principal. The Principal may revoke this Medical Power of Attorney at any time by notifying the Agent or a health care provider verbally or in writing.

Signature of Principal

Date: ____________ Signature: ___________________________

Signature of Agent

I, the Agent, accept this designation and agree to act in the Principal’s best interests to the best of my abilities. I understand my responsibilities and the limits of my authority as specified in this document and under Georgia law.

Date: ____________ Signature: ___________________________

Witnesses

The State of Georgia requires that this document be signed in the presence of two (2) adult witnesses. The witnesses cannot be the Agent, the Principal's health care provider, or employees of the health care provider. At least one of the witnesses must not be entitled to any portion of the Principal's estate upon death.

Signature of Witness #1

Date: ____________ Signature: ___________________________

Address: ____________________________________________

Signature of Witness #2

Date: ____________ Signature: ___________________________

Address: ____________________________________________

Download Medical Power of Attorney

Document Information

Fact Name Details
Definition A Georgia Medical Power of Attorney form allows an individual to appoint someone else to make healthcare decisions on their behalf if they become unable to do so.
Governing Law This form is governed by the Georgia Code, specifically O.C.G.A. § 31-36-1 through § 31-36-12.
Principal The person creating the Medical Power of Attorney is known as the principal.
Agent The individual appointed to make decisions is referred to as the agent or attorney-in-fact.
Durability The Medical Power of Attorney remains effective even if the principal becomes incapacitated, unless revoked.
Signature Requirement The form must be signed by the principal in the presence of two witnesses or a notary public to be valid.
Witnesses Witnesses must be at least 18 years old and cannot be related to the principal or the agent.
Revocation The principal can revoke the Medical Power of Attorney at any time, as long as they are competent.
Healthcare Decisions The agent can make a wide range of healthcare decisions, including medical treatments, surgeries, and end-of-life care.
Importance Having a Medical Power of Attorney is crucial for ensuring that your healthcare preferences are honored when you cannot communicate them yourself.
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