Hawaii Medical Power of Attorney
This document allows you to appoint someone to make medical decisions on your behalf in Hawaii. It is important to ensure your wishes are respected if you are unable to communicate them yourself.
Principal Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Date of Birth: ______________________
Agent Information:
- Name: ______________________________
- Address: ____________________________
- City, State, Zip: ____________________
- Phone Number: ______________________
Durability of Power:
This Medical Power of Attorney shall remain in effect until revoked by the Principal or until the Principal's death.
Health Care Instructions:
The Principal may provide specific instructions regarding medical treatment and care. Please indicate any preferences below:
- Life-sustaining treatment: ____________
- Organ donation: _____________________
- Other instructions: __________________
Signatures:
By signing below, the Principal confirms that they are of sound mind and understand the nature of this document.
Principal Signature: ___________________________ Date: _______________
Agent Signature: _____________________________ Date: _______________
Witnesses:
This document must be witnessed by two individuals who are not related to the Principal or Agent.
- Witness 1 Name: ___________________________ Signature: _______________ Date: _______________
- Witness 2 Name: ___________________________ Signature: _______________ Date: _______________
This Medical Power of Attorney is governed by the laws of the State of Hawaii.