Colorado Medical Power of Attorney
This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so. It is important to choose someone you trust. This Medical Power of Attorney is governed by Colorado law.
Principal Information:
- Name: ____________________________
- Address: __________________________
- City, State, Zip: ________________
- Date of Birth: ____________________
Agent Information:
- Name: ____________________________
- Address: __________________________
- City, State, Zip: ________________
- Phone Number: ____________________
Durable Medical Power of Attorney:
I, the undersigned, hereby appoint the above-named Agent as my attorney-in-fact to make health care decisions on my behalf if I become unable to make those decisions myself.
Limitations:
My Agent shall have the authority to make the following decisions:
- Consent to or refuse any medical treatment.
- Access my medical records.
- Make decisions about life-sustaining treatment.
This Medical Power of Attorney shall become effective upon my incapacity, as determined by my attending physician.
Signature:
_____________________________
Date: ________________________
Witnesses:
Two witnesses must sign below. They cannot be your Agent or related to you by blood, marriage, or adoption.
- Witness 1: ___________________________ Date: _______________
- Witness 2: ___________________________ Date: _______________
Notary Public:
State of Colorado
County of _______________
Subscribed and sworn before me on this _____ day of ____________, 20__.
_____________________________
Notary Public
My commission expires: _______________