Pennsylvania Medical Power of Attorney Form

A Pennsylvania medical power of attorney form allows a patient to select an agent to make health care decisions on their behalf. It is recommended for the principal to write their goals on how to best decide treatment options. The principal can also multiple agents to serve in case the primary agent is not available.

PDF

Updated April 17, 2025

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Signing Requirements

Two witnesses. Notarization is optional.^[1]^[2]

“Health Care Power of Attorney” Definition

A health care power of attorney is a writing made by a principal designating an individual to make health care decisions for the principal.^[3]

Statutory Form

The state of Pennsylvania does not offer a statutory form.

Sample

Download: PDF

Sources

Pennsylvania Medical Power of Attorney Form