Montana Durable Medical Power of Attorney Form

The Montana medical power of attorney form applies in accordance with § 509103(1)§ 53-21-1304(2)(d), and gives patients the right to appoint a person of authority in the event of them becoming seriously ill which causes them to become incapacitated. An agent can then make health care decisions on behalf of the patient. This authority also includes the decisions regarding end-of-life treatment. The document is ineffective if not witnessed by individiduals.

How to Write

Durable Power Of Attorney

The principal`s and agent`s details must be entered.

  • Principal`s name.
  • Principal`s city of residence.
  • Agent`s name.
  • Agent`s cit of residence.


Alternative Agents

8) The names of alternative agents must be entered.


Special Instructions

9) The specific details of any further instructions the principal wishes to express must be entered.


Determination Of Inability To Communicate

10) The principal must designate a person who is responsible for the time when they are deemed unable to communicate.

  • Name of designated person.
  • Date.
  • Principals signature.
  • County.
  • Date.
  • Signature of notary.
  • Name of notary.
  • Residence of notary.
  • Date of expiration of commission.