Pennsylvania Medical Power of Attorney Form

Last updated October 28th, 2021

  1. Home »
  2. Power of Attorney »
  3. Pennsylvania »
  4. Medical

Pennsylvania medical power of attorney is part of a health care directive that permits an agent to act on behalf of a principal and communicate their end-of-life medical choices. After the agent’s powers become effective, they will be responsible for making important medical decisions such as consenting to or rejecting life-prolonging treatment, surgery, pain relief medication, and blood transfusions.

Appointing an agent to make medical decisions for the principal is done by completing Part 1 of the document linked on this page. While it’s not a legal requirement, the principal may choose to complete the Living Will portion of form (Part 2) as well. The living will outlines the principal’s wishes and instructions for health care and treatments. Both forms together create a Pennsylvania Advance Directive.

Agent’s Duties § 5456

Laws Title 20, Chapter 54, Subchapter C (Health Care Agents and Representatives)

Signing Requirements (§ 5452) – Two (2) Witnesses

Statutory Form § 5471

State Definition

Statute§ 5422

“Health care power of attorney.”  A writing made by a principal designating an individual to make health care decisions for the principal.