Select Your Healthcare Agent

1. Print a Durable Power of Attorney for Healthcare.

In 45 states you can use the Universal Durable Power of Attorney for Healthcare prepared by the American Bar Association’s Commission on Law and Aging. Click here to print a copy of this form.
If you live in Indiana, New Hampshire, Ohio, Texas or Wisconsin, click on the name of your state to print your Healthcare Advance Directive form.

Select someone you trust and feel confident will be able to understand and follow your wishes for end-of-life care. It’s best if your Agent lives near you or can travel to be with you when needed.
You can select a family member to be your Agent, however it’s generally better not to choose a family member who doesn’t understand or agree with your healthcare decisions.
Make sure that the person you pick is willing to be your Healthcare Agent, and is comfortable talking with you about your end-of-life wishes.
Choose someone who can be a strong advocate for you, both with your family members and friends, and with medical personnel.
Name one person as your primary Agent, and then select at least one back-up Agent, in case the first person is not available when needed.

Fill in the required information about yourself, your Healthcare Agent, and any back-up Agents.
Sign your form in the presence of two witnesses. You may also sign with a notary public. Be sure to follow the instructions for signing and witnessing the signature included on the form.

Give copies of the signed form to your Healthcare Agents, family members, and healthcare providers.
Store your original Durable Power of Attorney for Healthcare in your End-of-Life Binder.