Nebraska Durable Medical Power of Attorney Form

The Nebraska medical durable power of attorney form is a document that is provided by the state of Nebraska to let the principal choose an `Agent` or `Power Of Attorney`, to decide on the care the principal gets should they become incapacitated through illness. It is legally binding according to US statutes § 30-3401 to -3432 unless the principal is found to be pregnant. Completion of the document will require 2 witnesses or a notary before it is legal.

How to Write

Power Of Attorney For Health Care

1) The principal must appoint an attorney-in-fact and an alternative attorney-in-fact.

  • Names of attorney-in-fact.
  • Addresses of attorney-in-fact.
  • Telephone numbers of attorney-in-fact.


2) The principal must enter the details of any limitations or instructions they have with regards to their medical health care.


3) The principal must enter details of their wishes regarding life sustaining treatment.


4) The principal must enter details of their wishes regarding artificial hydration and nutrition.


The principal must then sign the bottom of the page.


Declaration Of Witnesses

The witnesses to this document must enter their details.

  • Signature.
  • Printed name.
  • Date.