Free Template for Advance Medical Directive and Medical Power of Attorney (POA) in Virginia

Planning for future healthcare decisions is essential, and having an Advance Medical Directive or Medical Power of Attorney (POA) in place ensures that your healthcare wishes are followed if you're unable to make decisions for yourself. For Virginia residents, this free, customizable template provides the legal foundation to appoint a healthcare agent, express your preferences for medical treatment, and outline the authority you grant to your healthcare proxy.

In this guide, we’ll cover the importance of an Advance Medical Directive or Medical POA in Virginia, offer a free template, and highlight key considerations for ensuring your healthcare decisions are respected.

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What Is an Advance Medical Directive?

An Advance Medical Directive is a legal document that allows you to appoint a healthcare agent (or proxy) and outline your healthcare preferences if you’re unable to communicate or make decisions for yourself. This can include instructions regarding life-sustaining treatment, organ donation, and specific medical treatments you do or do not want.

For more detailed information on Virginia Advance Medical Directives, you can refer to the Virginia State Bar and Virginia Department of Health.

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Why Do You Need a Medical POA in Virginia?

A Medical Power of Attorney (POA) grants a trusted person the authority to make healthcare decisions on your behalf when you're unable to do so. It’s important to have this document in place to ensure that your medical preferences are honored and that a person you trust is making these decisions on your behalf.

Without an Advance Medical Directive or Medical POA, your healthcare providers and family members may not have clear guidance on your wishes, and in some cases, the court may need to appoint a guardian to make decisions on your behalf. Having these documents prepared in advance is crucial to protecting your autonomy.

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Free Advance Medical Directive and Medical Power of Attorney Template for Virginia

Below is a free, customizable template for residents of Virginia. Please tailor it to fit your personal preferences and consult with an attorney if necessary.

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Advance Medical Directive and Medical Power of Attorney

I, [Your Full Name], residing at [Your Address], in the City of [Your City], County of [Your County], Commonwealth of Virginia, being of sound mind, hereby make this Advance Medical Directive.

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Section 1: Appointment of Agent

I hereby appoint [Agent's Full Name], residing at [Agent's Address], in the City of [Agent's City], County of [Agent's County], Commonwealth of Virginia, as my healthcare agent (also referred to as my healthcare proxy or attorney-in-fact) to make any and all healthcare decisions for me if I am unable to make or communicate such decisions myself.

Alternate Agent (in case the primary agent is unavailable):

• Name: [Alternate Agent's Full Name]
• Address: [Alternate Agent's Address]

Initial Here: ________

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Section 2: Statement of Desires, Special Provisions, and Limitations

In this section, express your wishes regarding:

• Life-sustaining treatment:
  (e.g., “I do/do not want life-sustaining treatments like ventilators or feeding tubes if I am in a terminal condition.”)
  Initial Here: ________
• Organ donation:
  (e.g., “I consent/do not consent to organ donation.”)
  Initial Here: ________
• Specific treatments:
  (e.g., “I wish/do not wish to receive pain management.”)
  Initial Here: ________

Additional Limitations on Agent's Authority (optional):

[Insert any limitations or leave blank]
Initial Here: ________

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Section 3: Effectiveness

This Advance Medical Directive shall become effective if I am unable to make or communicate my own healthcare decisions, as determined by my attending physician and one other physician or licensed clinical psychologist who has examined me.

Initial Here: ________

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Section 4: Agent’s Authority

My agent shall have the full power and authority to make any and all healthcare decisions for me, including but not limited to the following:

• Consent to or refuse any medical treatment, procedure, or test.
  Initial Here: ________
• Select healthcare providers and medical facilities.
  Initial Here: ________
• Access my medical records.
  Initial Here: ________
• Make decisions regarding life-sustaining treatment, including the withdrawal or withholding of such treatment.
  Initial Here: ________
• Make decisions regarding organ donation.
  Initial Here: ________
• Make decisions regarding the disposition of my remains after death.
  Initial Here: ________

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Section 5: Revocation

I may revoke this Advance Medical Directive at any time by notifying my agent and my healthcare providers in writing.

Initial Here: ________

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Section 6: Signature and Witnesses

I understand the full implications of this Advance Medical Directive and Medical Power of Attorney, and I sign it freely and voluntarily.

Signature: _______________________________
Date: _______________________________

Witness 1

Name: _______________________________
Signature: _______________________________
Date: _______________________________

Witness 2

Name: _______________________________
Signature: _______________________________
Date: _______________________________

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Important Considerations for Virginia Residents

• Two Witnesses Are Required: Virginia law mandates that two witnesses sign the document, and they should not be your healthcare agent or related to you by blood or marriage. You can review more details at the Virginia Advance Directive Registry.
• Discuss with Your Agent: Ensure that your healthcare agent understands your wishes and is comfortable making decisions on your behalf.
• Consult an Attorney: It is recommended to consult an attorney to ensure this document fully complies with Virginia law and reflects your specific preferences.

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Why Choose DC Mobile Notary for Your Advance Medical Directive?

At DC Mobile Notary, we offer convenient, mobile notary services to help you get your Advance Medical Directive or Medical POA notarized wherever you are. Our professional services ensure your documents are legally valid, and we offer:

• Mobile Notary Convenience: We come to your home, office, or healthcare facility.
• Expert Assistance: We handle sensitive documents with care and professionalism.
• Confidentiality: Your privacy and personal information are guaranteed.

Contact DC Mobile Notary Today:

• Phone: +1 (202) 247-0837
• Email: support@dcmobilenotary.com
• Website: https://www.dcmobilenotary.com/

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Disclaimer

This template is provided for informational purposes only and does not constitute legal advice. It is recommended to consult with an attorney to ensure that this document complies with Virginia state laws and fully reflects your healthcare wishes. DC Mobile Notary is not responsible for any legal outcomes from the use of this template.

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