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 - Northwestern Memorial Hospital - Chicago

Power of Attorney for Healthcare

A medical power of attorney allows you to select a significant other, family member or friend as your medical decision-maker should you become unable to make medical decisions. This decision maker is known as your agent. Your agent must be 18 years of age. The document covers health care matters only and goes into effect only when you become unconscious or unable to make medical decisions. You can specify in writing the types of care you do and do not want to receive.

In Illinois, a power of attorney form does not have to be prepared by a lawyer and it does not need to be notarized. You can change your power of attorney choices at any time. Make sure your agent and your doctor know your wishes and have the latest copy of your power of attorney.

A Voice in Your Future (pdf) provides a detailed overview of power of attorney and how it can help you and your chosen agent.

Steps to complete the power of attorney for healthcare:

  1. Download the form –  Power of Attorney (pdf)  Power of Attorney - Español (pdf)
  2. Select an agent – someone with whom you have discussed your wishes and who is able and willing to represent them. Your agent does not have to be a family member.
  3. Identify a 2nd agent in case your 1st agent is not available.
  4. Fill-in all blanks.
  5. Be sure to include your agent’s phone number(s).
  6. Select one witness other than your agent who is 18 years of age or older.
  7. Your witness should be present when you sign the document.
  8. Make copies for yourself, your agent, your family and your doctor.

(Adobe Acrobat Reader needed to download form)

Last UpdateApril 16, 2014