Colorado Durable Medical Power of Attorney Form

The Colorado medical power of attorney document provides the facility for patients to appoint a legal independent authority sometimes referred to as the Agent. In the event of an illness which causes the patient to become incapacitated the agent is able to make the decisions that relate to the patient’s health care treatment. This authority also includes the decisions regarding end-of-life treatment, for example, life support or nutrition delivery.

This document requires attestation by two (2) witnesses or a notary public in accordance with § 15-18-106(1).

How to Write

1) Principal`s Details

Enter principals details. Enter Agent`s and alternative agent`s details.

  • Principal`s name.
  • Agent`s name.
  • Agent`s address.
  • Agent`s home telephone number.
  • Agent`s work telephone number.

A) Statement of life regarding prolonging of life.

  • Enter any other details regarding the wishes of the principal for end of life health care.

B) Special Provisions.

  • Enter details of any other special provisions for the patient.



Enter details of principal.

  • Signature.
  • Date.


Witnesses (Optional)

Enter details of witnesses.

  • Signature.
  • Home address.
  • Date.