Special Power of Attorney for Medical Authorization Free Legal Form

Special Power of Attorney for Medical Authorization

I, ______________________, of ___________________, hereby appoint ______________________________ of __________________________, as my attorney in fact to act in my capacity to do any and all of the following:
1. Make any and all decisions and authorize all procedures that _________ may deem necessary regarding the medical treatment of my children, __________ and/or ____________.
The rights, powers, and authority of my attorney in fact to exercise any and all of the rights and powers herein granted shall commence and be in full force and effect and shall remain in full force and effect until __________________________ or unless specifically extended or rescinded earlier by either party.
Dated _________________________, 20___.
__________________________

STATE OF ___________________
COUNTY OF __________________
BEFORE ME, the undersigned authority, on this ___ day of _______________, 20___, personally appeared ______________________ to me well known to be the person described in and who signed the Foregoing, and acknowledged to me that he executed the same freely and voluntarily for the uses and purposes therein expressed.
WITNESS my hand and official seal the date aforesaid.
___________________________
NOTARY PUBLIC
My Commission Expires:______

This legal form, letter, or template should not be used without consulting an attorney first. It may not be valid in your state, country or jurisdiction.

If you can't find what you need in our free forms, templates, and letters, over 25,000 forms covering almost every topic can be found here or even more here. These forms cost a few dollars, but generally are available in customized versions for various states and are usually more complete.