Washington Medical Power of Attorney Form

The Washington medical power of attorney form gives the principal the option to formally choose someone who is to be an `Agent` to make health care decisions for them. The principal may limit the powers of the agent as well as adding other medical health care preferences which are personal to them. This power of attorney is in case the principal becomes so ill that they are incapacitated to a point that are no longer able themselves to make their medical health care choices, this can be for example due to a coma or permanent brain damage. It applies in accordance with US statutes §11.94.010 to .901.

How to Write

Durable Power Of Attorney For Health Care

Designation Of Health Care Agent

The details of an appointed agent must be entered.

  • Principals name.
  • Agent`s name.
  • Agent`s address.
  • Agent`s ZIP code.
  • Agent`s telephone number.


The principal must print their name at the top of page 2.


Special Provisions

The principal may enter details of any other special provisions they have regarding their medical health care.

  • Specific directions.
  • Date.
  • Principal`s signature.



The notary`s details must be entered.

  • County.
  • Name of principal.
  • Date.
  • Signature of notary.
  • Residence of notary.
  • Date of expiration of commission.