Homepage Fillable Medical Power of Attorney Template for New Hampshire
Outline

In New Hampshire, preparing for future healthcare decisions is crucial, and one effective way to ensure your preferences are respected is through the creation of a Medical Power of Attorney (MPOA) form. This legal document allows you to designate an individual, known as an agent, to make healthcare decisions on your behalf should you become incapacitated or otherwise unable to communicate your wishes directly. Covering a broad range of decisions, from routine medical care to life-sustaining treatments, the MPOA is an essential tool for anyone looking to have a say in their medical care when they are not able to verbalize it themselves. Completing this form requires careful consideration, including choosing a trustworthy agent, understanding the specific powers granted, and recognizing when the agreement comes into effect. By establishing a Medical Power of Attorney, you can provide clear instructions and peace of mind for yourself and your loved ones about your healthcare preferences.

Document Sample

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). It is a legal document that allows you, the Principal, to designate a trusted individual, referred to as the Agent, to make health care decisions on your behalf should you become unable to do so.

Principal Information

  • Full Name: _______________
  • Address: _______________
  • City: _______________ State: _______________ ZIP Code: _______________
  • Date of Birth: _______________
  • Social Security Number: _______________

Agent Information

  • Full Name: _______________
  • Relationship to Principal: _______________
  • Primary Phone Number: _______________
  • Alternate Phone Number: _______________
  • Email Address: _______________

Alternate Agent Information (Optional)

If the primary agent is unable or unwilling to act, the following individual is designated as the alternate agent:

  • Full Name: _______________
  • Relationship to Principal: _______________
  • Primary Phone Number: _______________
  • Alternate Phone Number: _______________
  • Email Address: _______________

General Powers Granted

This document grants the Agent the power to make any and all health care decisions for the Principal that the Principal could make if capable. These decisions can include consenting to or refusing medical treatment, accessing medical records, and making decisions about organ donation, artificial nutrition, and hydration.

Specific Instructions

The Principal may state specific wishes, limitations, or instructions concerning health care decisions:

PDF Form Breakdown

Fact Name Description
Governing Law New Hampshire Revised Statutes, Chapter 137-J: The Durable Power of Attorney for Health Care Act governs the Medical Power of Attorney in New Hampshire.
Definition In New Hampshire, a Medical Power of Attorney is a legal document that allows you to designate someone (known as an "agent") to make health care decisions on your behalf if you become unable to do so.
Agent Authority The agent can make a wide range of health care decisions on your behalf, including the refusal or request of treatment, except as limited by law or the document itself.
Limitations By law, the agent cannot consent to certain treatments such as involuntary commitment or psychosurgery unless specifically authorized in the document.
Witness Requirements Your Medical Power of Attorney must be witnessed by two adults who are not related to you by blood, marriage, or adoption and who are not your healthcare providers or employees of your healthcare providers.
Revocation You retain the right to revoke your Medical Power of Attorney at any time, as long as you can communicate your wishes in any way. This can be done verbally, in writing, or by any other act evidencing a specific intent to revoke the power granted.
Validity Across State Lines While New Hampshire will recognize a Medical Power of Attorney that is validly executed in another state, it's important to ensure it complies with New Hampshire’s specific laws and standards to avoid any issues.

How to Use New Hampshire Medical Power of Attorney

In New Hampshire, creating a Medical Power of Attorney (MPOA) is a proactive step to ensure your health care decisions are in trusted hands should you be unable to make them yourself. This document allows you to appoint someone you trust, often referred to as an agent, to make health care decisions on your behalf. Although the process may seem daunting at first, properly completing this form is straightforward with careful attention. The key is to ensure that your wishes are clearly communicated and legally recognized. The steps outlined below are designed to guide you through this important process.

  1. Start by downloading the official New Hampshire Medical Power of Attorney form. Ensure that you have the most recent version by checking the New Hampshire Department of Health and Human Services website or consulting a legal professional.
  2. Read the instructions provided carefully before filling out the form. These instructions often contain important information about how to correctly complete the form and specify which sections must be filled out.
  3. Fill in your full legal name and address at the top of the form. This identifies you as the principal—the person who is delegating authority to another.
  4. Identify your chosen agent by writing their full legal name, relationship to you, and contact information. This is the person you are trusting to make health care decisions on your behalf if you are not able to do so.
  5. If desired, appoint an alternate agent by providing their name and contact details. This step is optional but recommended in case your primary agent is unavailable or unwilling to act on your behalf at the necessary time.
  6. Clearly specify any limitations on your agent’s authority. If there are specific treatments you do not want or other restrictions you want to apply to your agent’s decision-making power, describe these clearly on the form.
  7. Determine the effective date of the MPOA. This can be immediately upon signing or when a doctors determine you are unable to make your own medical decisions. Indicate your choice clearly on the form.
  8. Discuss your wishes with your chosen agent and alternate agent, if applicable. It’s essential that they understand your preferences and are willing to act according to your directives.
  9. Sign and date the form in the presence of two adult witnesses who are not related to you and who will not benefit from your estate. Their role is to verify your identity and attest that you are signing the document of your own free will.
  10. Depending on New Hampshire requirements, you may also need to have the form notarized. Check the latest state guidelines to ensure your MPOA complies with all current legal requirements.
  11. After completing the form, make copies for your agent, alternate agent, and primary healthcare provider. Consider also storing a digital copy in a secure place where it can be accessed by your agent if needed.

Once your Medical Power of Attorney form is properly filled out and stored safely, you can have peace of mind knowing that your health care decisions will be in trusted hands should the situation arise. Remember, this is a powerful document that can be updated or revoked by you at any time as long as you are competent. It's a good practice to review and possibly update your MPOA periodically, especially after major life events or changes in your health status.

Understanding 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 allowing a person (the principal) to designate another individual (the agent) to make healthcare decisions on their behalf if they become unable to do so. This can include decisions regarding treatments, medical procedures, or other healthcare services.

Who can be appointed as an agent in New Hampshire?

In New Hampshire, an agent must be a competent adult. The principal can choose a family member, friend, or anyone they trust to make decisions in their best interest. It's important that the chosen agent is willing to accept this responsibility and understands the principal’s healthcare wishes.

How do I choose an agent for my Medical Power of Attorney?

When choosing an agent, consider someone who respects your values, understands your wishes for medical treatment, and is willing and able to advocate on your behalf. Discuss your healthcare beliefs and desires with them to ensure they are comfortable with the responsibility and will make decisions that align with your preferences.

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

A Medical Power of Attorney becomes effective when the principal is determined to be incapable of making their own healthcare decisions. This determination must be made in writing by the principal's attending physician or by a second medical or mental health professional.

Can I revoke or change my Medical Power of Attorney?

Yes, in New Hampshire, you can revoke or change your Medical Power of Attorney at any time, as long as you are competent. To revoke, you should inform your healthcare provider and the agent verbally and in writing. To make changes, complete a new Medical Power of Attorney form and provide copies to your healthcare providers and your new agent, if applicable.

What should I do with my completed Medical Power of Attorney form?

Once completed, copies of your Medical Power of Attorney form should be given to your agent, family members, and any healthcare providers, such as your doctor or hospital. It’s also wise to keep a copy in a safe place where it can be easily accessed when needed.

Is a lawyer needed to create a Medical Power of Attorney in New Hampshire?

While it is not required to have a lawyer to create a Medical Power of Attorney in New Hampshire, consulting with one can ensure that the document meets all legal requirements and accurately reflects your wishes. A lawyer can also provide valuable advice on choosing an agent and discussing your healthcare preferences.

Common mistakes

When preparing a Medical Power of Attorney (MPOA) in New Hampshire, individuals often overlook critical details that can significantly affect the document's validity and effectiveness. An MPOA is a legal tool that allows someone to appoint a trusted person to make healthcare decisions on their behalf if they cannot do so themselves. While this document is essential for planning for future health care needs, certain mistakes can hinder its intended purpose.

One common error is not specifying the powers granted clearly. The MPOA form requires the person completing it to detail the extent of decision-making authority they are giving to their agent. Some people make the mistake of leaving this section vague or incomplete, which can lead to confusion and conflict among family members, healthcare providers, and the appointed agent about what decisions can be made. It's crucial to be as explicit as possible about what the agent can and cannot do.

  1. Failing to choose an alternate agent. Many people neglect to appoint a successor agent in the event that their first choice is unable or unwilling to serve. This oversight can leave individuals without a designated decision-maker at a critical time. Including at least one alternate agent ensures continuous representation of the person's wishes.
  2. Ignoring the need for witnesses or notarization. New Hampshire law requires that the MPOA form be either witnessed by two adults who are not related to the principal by blood, marriage, or adoption and who are not beneficiaries of the principal's estate, or notarized. Skipping this step can render the document legally ineffective.
  3. Not discussing the appointed powers with the chosen agent. It is imperative for individuals to have a thorough conversation with their chosen agent about their health care preferences and expectations. Without this crucial step, agents may be unaware of their responsibilities, leading to decisions that might not align with the principal's wishes.
  4. Omitting pertinent health information. Some individuals forget to include comprehensive health information that could inform decisions made by their agent. This information, including allergies, pre-existing conditions, and specific treatments or medications preferred, is essential for informed decision-making.

By avoiding these mistakes, individuals can ensure their Medical Power of Attorney form in New Hampshire is robust and clear, ultimately safeguarding their healthcare wishes and providing peace of mind. It's advisable for individuals to consult with a legal professional to help navigate the complexities of estate planning and healthcare directives, ensuring all legal requirements are met and the document accurately reflects their wishes.

Documents used along the form

When preparing for future healthcare decisions, individuals often complete a New Hampshire Medical Power of Attorney form. This critical document allows them to appoint someone they trust to make healthcare decisions on their behalf should they become unable to do so. However, to ensure comprehensive planning, it's equally essential to be aware of and consider other legal forms and documents that support or complement the intent of a Medical Power of Attorney. Here is a look at some of these vital documents.

  • Advance Directive: This document combines a Living Will and a Medical Power of Attorney, allowing an individual to outline their healthcare preferences and appoint a decision-maker.
  • Living Will: It specifies an individual's wishes regarding medical treatment, particularly about life-sustaining measures, in case they are incapacitated and unable to communicate their decisions.
  • Durable Power of Attorney: Unlike a Medical Power of Attorney, which is limited to healthcare decisions, a Durable Power of Attorney grants an appointed person the authority to make a broad range of legal and financial decisions on behalf of the signer.
  • HIPAA Release Form: This form gives healthcare providers the permission to share an individual's medical records with designated people, often including the person named in a Medical Power of Attorney.
  • Do Not Resuscitate (DNR) Order: A doctor's order that tells healthcare professionals not to perform CPR if a person's breathing stops or if their heart stops beating.
  • Organ Donor Form: Allows individuals to record their decision to donate their organs and tissues after death.
  • Guardianship: A legal process by which the court appoints an individual to make decisions for someone who is mentally incapacitated. This is usually considered when no Power of Attorney exists.
  • Healthcare Instructions: Sometimes a separate document from the Living Will, these instructions provide specific preferences for treatment options, care settings, pain management, and other healthcare considerations.
  • Funeral Planning Declaration: Allows individuals to outline their preferences for funeral arrangements and the handling of their remains, easing the decision-making burden on loved ones.

Together with a Medical Power of Attorney, these documents form a comprehensive healthcare directive plan, ensuring individuals' healthcare wishes are respected and legally recognized. Proper preparation and understanding of each form's purpose offer peace of mind to both the individuals involved and their families, ensuring that choices about personal health and end-of-life care are made according to their values and preferences.

Similar forms

The New Hampshire Medical Power of Attorney form is similar to several other key documents individuals often consider when planning for unforeseen circumstances. These documents include the Advance Healthcare Directive (Living Will), Durable Power of Attorney for Finances, and the Do Not Resuscitate (DNR) orders. Although these forms may seem to overlap in their purposes, each serves a unique role in a comprehensive estate or personal planning framework.

The Advance Healthcare Directive, commonly referred to as a Living Will, is closely related to the Medical Power of Attorney. While the Medical Power of Attorney appointee can make a range of health-related decisions on your behalf, a Living Will explicitly states your wishes regarding end-of-life care. Essentially, it sets out the treatments you do or do not want to be used to keep you alive, as well as your preferences for other medical decisions, like pain management or organ donation. The Living Will speaks when you cannot, guiding healthcare providers and your appointed agent in the Medical Power of Attorney to ensure your treatment preferences are respected.

A Durable Power of Attorney for Finances is another document that, like the Medical Power of Attorney, allows you to appoint an agent to act on your behalf. However, the key difference lies in the scope of authority granted. Instead of healthcare decisions, this form empowers your agent to manage your financial affairs. This could include paying your bills, managing real estate, or overseeing investments. It becomes effective during periods of incapacitation, ensuring that your financial matters are handled according to your wishes and maintaining your and your family's financial stability.

Do Not Resuscitate (DNR) orders are medical orders that are more specific than a Medical Power of Attorney or a Living Will. They tell healthcare professionals not to perform CPR if your breathing stops or if your heart stops beating. A DNR is very specific and is usually considered by individuals with a terminal illness, those who are at a significant risk of death in the near future, or those who simply do not wish to have CPR performed on them in these events. While a Medical Power of Attorney may include decisions about a wide range of medical treatments and interventions, a DNR specifically addresses CPR and does not cover other medical treatments.

Dos and Don'ts

When preparing the New Hampshire Medical Power of Attorney form, individuals should follow specific guidelines to ensure the document meets legal requirements and accurately reflects their healthcare wishes. Understanding what actions to take and what mistakes to avoid can simplify the process and enhance the effectiveness of the document.

Things You Should Do

  1. Review the form carefully before starting, making sure to understand each section and its purpose.
  2. Include complete and accurate personal information for both the principal (the person granting the power) and the agent (the person being granted the power).
  3. Discuss your healthcare wishes in detail with the agent you have chosen, ensuring they understand and are willing to uphold your decisions.
  4. Sign the document in the presence of two witnesses or a notary public, as required by New Hampshire law, to validate the form.
  5. Keep the original document in a secure yet accessible place and provide copies to your agent, close family members, and healthcare providers.
  6. Review and potentially update the document periodically, or after major life events such as marriage, divorce, or the diagnosis of a serious illness.
  7. Consult a legal professional if you have any questions or concerns about the form or the process.

Things You Shouldn't Do

  • Do not leave any sections incomplete or skip any steps in the process, as this may lead to issues with the document's legality or enforceability.
  • Do not choose an agent without discussing it with them first, to confirm their willingness and ability to act on your behalf.
  • Do not neglect to discuss your medical wishes with your chosen agent, even if you think they already know what you want.
  • Do not forget to sign and date the form in accordance with New Hampshire legal requirements, which may include witnessing or notarization.
  • Do not keep the completed document hidden or in a place where it cannot be found in an emergency.
  • Do not assume the form is a one-time task; review and update it as needed to reflect your current wishes and circumstances.
  • Do not attempt to navigate complex legal questions without seeking appropriate legal advice.

Misconceptions

Many people have misconceptions about the New Hampshire Medical Power of Attorney (MPOA) form, which can lead to confusion and mismanagement of an individual's health care wishes. Understanding these misconceptions is crucial for ensuring that your health care preferences are respected and communicated effectively.

Misconception 1: A Medical Power of Attorney is the same as a living will.

Although both documents address medical decisions, they serve different purposes. A Medical Power of Attorney designates an agent to make health care decisions on your behalf if you are unable to do so, whereas a living will expresses your wishes regarding end-of-life care.

Misconception 2: Once appointed, your agent has immediate control over your medical decisions.

In reality, your agent’s authority to make decisions on your behalf is activated only under the conditions specified in the MPOA document, typically when you are deemed unable to make decisions for yourself by a health care provider.

Misconception 3: Any family member can act as your agent without formal designation.

This is a common misunderstanding. While family members may be consulted, having a Medical Power of Attorney in place is necessary to legally designate someone to make decisions on your behalf. Without this document, decisions may not reflect your wishes or values.

Misconception 4: Your agent can make decisions about your finances.

The authority of your agent under a Medical Power of Attorney is limited to health care decisions. Financial decisions require a separate document, often called a Durable Power of Attorney for finances.

Misconception 5: You cannot change your Medical Power of Attorney once it is signed.

As circumstances change, you may want to appoint a different agent or alter your health care preferences. You have the right to revise your MPOA document at any time, as long as you are considered mentally competent to make these decisions.

Misconception 6: The Medical Power of Attorney form is complicated and requires a lawyer to complete.

While legal advice can be helpful, especially in complex situations, New Hampshire provides resources and straightforward forms for individuals to designate a Medical Power of Attorney. It is important to follow the state’s guidelines to ensure the document is legally valid, but a lawyer is not strictly necessary for completion.

Key takeaways

Completing the New Hampshire Medical Power of Attorney form is a critical step in managing your healthcare decisions. This document enables you to appoint a trusted individual to make healthcare decisions on your behalf, should you be unable to do so yourself. Here are key takeaways to ensure the process is handled properly:

  • Choose your agent carefully. The person you appoint as your agent will have the authority to make significant healthcare decisions for you. Ensure this is someone you trust completely and who understands your wishes.
  • Discuss your healthcare wishes with your agent. It's crucial that your agent knows what you want. Take the time to discuss your healthcare preferences, including treatments you would or wouldn't like to receive under various circumstances.
  • Understand the scope of the document. The Medical Power of Attorney form grants your agent broad powers to make healthcare decisions on your behalf. This includes the ability to consent to, refuse, or withdraw treatment and to access your medical records.
  • Sign in the presence of witnesses or a notary. New Hampshire law may require your Medical Power of Attorney form to be either witnessed or notarized, depending on the specific requirements at the time of execution. This step is vital to ensure the document's legal validity.
  • Keep the original document accessible. Once the form is completed and signed, keep the original document in a safe but accessible place. Inform your agent, close family members, and your healthcare provider of its location.

Properly executing the New Hampshire Medical Power of Attorney form is a proactive step towards ensuring your healthcare wishes are respected. This process, though solemn, is an act of care for yourself and eases the burden on loved ones during difficult times.

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