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Delaware Durable Medical Power of Attorney Form |
The Delaware Power Of Attorney For Health Care form is a document which legally allows a Principal to appoint an `Agent` who can act as the power of attorney with regards to the patient`s health care in case they become so ill that they are unable to make vital decisions themselves. The document requires two witnesses, one witness then they may not be a relative or health care provider of the principal. The document is in accordance with § 2503(b)(1).
How to Write
1) The principal must enter their Personal Information in the blank fields.
- Full name..
- State.
- Date form was written.
- Date of birth.
Part 1. Health Care Agent
The Agents Personal Information must be entered in the blank fields.
- Full name
- Address
- ZIP code
- Daytime telephone number
- Other telephone number
Part 2. Choosing A Back Up Agent (Optional)
The Back Up Agents Personal Information (In case the first choice agents are unavailable) must be entered in the blank fields.
- Full name
- Address
- ZIP code
- Daytime telephone number
- Other telephone number
Part 3. The Agents Powers
The principal must carefully read the list of agents requirements, especially the first power, initialing in the space provided.
- Initial
Part 4. Special Instructions Or Limitations Of Agents Power
- Enter in the blank space any other special requirements or limitations.
Part 7. Sign
The principal must enter their personal details.
- Signature
- Print full name
- Date
Statement By The Witnesses
The witnesses must enter their personal details.
- Print full name
- Signature
- Date
- Address
- ZIP code
Residents of Missouri, North Carolina, South Carolina or West Virginia, must have this form notarized.
The details of the notary must be entered.
- State
- County
- Date
- Name of Principal
- Names of witnesses
- Signature of notary
- Date commission expires
