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Washington Medical Power of Attorney Form

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Washington Medical Power of Attorney Form sets a specific individual as a health care representative acting for a declarant (patient) when he or she cannot act independently or is incapacitated. Only the declarant or patient wishing to name his or her health care representative may execute this form and sign it as an issuing principal. Before doing so, however, it is imperative that the principal (declarant/patient) sit down with the individual he or she wishes to name as the health care representative for a frank discussion regarding treatment preferences and options. This delegation of power will rely heavily on the health care representative’s understanding of the principal’s wishes for the principal’s expectations to be met. It should be mentioned the principal issuing this paperwork is the only one who can revoke it. Such a revocation can be issued at any time at the principal’s discretion.

DefinitionRCW 70.122.020

LawsRCW 70.122.030

Living Will – A declaration that sets a person’s rights to select their end of life treatment options, in reference to withdrawing life-sustaining procedures, if they should be in a permanently unconscious state. The Advance Directive may also be completed which combines both these forms.

Durable (Financial) Power of Attorney – This Power of Attorney document is employed to select an agent to oversee the Principal’s finances.

How to Write

1 – The Document Available Through The Caption Buttons Should Be Downloaded

Locate and select one of the caption buttons under the image on this page to designate a Health Care Agent in the State of Washington. It is recommended you save a copy of this paperwork to your machine.

2 – The Terminology Supplied Here Requires Attention

The first section of this document should be given an in-depth review by the Principal. This Notice will provide some important information regarding the Principal and Health Care Agent requirements. The second item presented in this directive will serve to name the Attorney-in-Fact the Principal intends to nominate with Principal Health Care Agent Powers. To begin, fill in the Principal’s Full Legal Name to the first blank line under the bold title “Designation Of Health Care Agent And Alternate Agents.”

The area directly below the reported Principal Name shall contain several blank lines which focus on the Attorney-in-Fact. Use these lines to declare the Attorney-in-Fact’s “Name,” “Address,” “City,” “State,” “Zip,” and “Phone” Number. Sometimes, a Principal may need a Health Care Agent’s representation at a time when the Health Care Agent is unavailable or in a way the Health Care Agent may not act. At any rate, some individuals may wish to take the added precaution of naming a Successor Agent who will automatically be able to assume the Principal Powers of the Health Care Agent. If the Principal of this paperwork wishes to enact this option, then record the Name of the Primary Health Care Agent on the blank after the words “In The Event That…” Now, under the statement “…Is Unable Or Unwilling To Serve, I Grant These Powers To” record the Successor Agent’s Full Name and Complete Address using the appropriately labeled blank lines. In addition to a Successor Agent, a Second Successor Agent may be added to the roster, if additional security is required. To designate a Second Successor Agent, supplement the statement “In The Event That Both…” with the Name of the Health Care Agent and that of the Successor Agent.  Utilize the blank lines (“Name,” “Address,” “City,” “State,” “Zip,” and “Phone”) under the reported Names above to document the Identity and Contact Information of the Second Successor Agent.

3 – Special Provisions To This Directive Can Be Included With The Principal Powers

The next section, “3. General Statement Of Authority Granted,” will supply the language that must be present when granting the Authority to make Health Care Decisions on behalf of the Signature Principal. It should be read and understood by the Principal before the execution of this paperwork. “4. Special Provisions” will act as a tool enabling the Principal to directly report his or her preferences, expectations, instructions, specifications, and limitations or restrictions to the Health Care Agent’s General Powers. A few blank lines have been supplied to this section, however, if more room is necessary for a full report then continue on an attachment.

4 – The Signature Principal Must Have This Document Notarize Upon Signing

Once the Principal is satisfied with the contents of this paperwork, he or she should record the Calendar Date of his or her Signature across the three empty lines after the words “Dated This…” The Principal must sign the line labeled “Grantor (My Signature)” then, release this document to the Notary Public. The Notary Public will present some basic facts regarding this signing along with his or her credentials.