Article Guide
In New Jersey, the Medical Power of Attorney form serves as a crucial legal document that empowers individuals to designate a trusted person to make healthcare decisions on their behalf in the event they become unable to communicate their wishes. This form is particularly important for ensuring that your medical preferences are honored, even when you cannot voice them yourself. It allows you to select a healthcare representative who understands your values and can advocate for your treatment choices, whether it involves life-sustaining measures or end-of-life care. By outlining your preferences clearly, the Medical Power of Attorney helps to alleviate the burden on family members during difficult times, ensuring that they can focus on providing emotional support rather than navigating complex medical decisions. Additionally, this form can be tailored to reflect your specific desires regarding medical interventions, making it a personalized tool in your healthcare planning. Understanding the importance of this document and how to properly execute it is essential for anyone looking to take control of their medical future.
Example - New Jersey Medical Power of Attorney Form
This Medical Power of Attorney is established in accordance with the laws of the State of New Jersey, specifically the New Jersey Advance Directive for Health Care Act. It empowers the individual(s) named herein to make healthcare decisions on behalf of the undersigned, should the undersigned become unable to participate in medical treatment decisions.
Part 1: Information of the Principal
Full Name of Principal: _______________________________________
Principal's Date of Birth: _____________________________________
Address of Principal: __________________________________________
City, State, Zip: ______________________________________________
Principal's Telephone Number: __________________________________
Part 2: Designation of Health Care Representative
I, ______________________ (Principal's name), hereby designate the following individual as my Health Care Representative to make health care decisions on my behalf:
Full Name of Health Care Representative: ________________________
Relationship to Principal: _____________________________________
Address of Health Care Representative: __________________________
City, State, Zip: ______________________________________________
Health Care Representative's Telephone Number: __________________
Alternate Health Care Representative
If my primary Health Care Representative is unable, unwilling, or unavailable to act in such capacity, I hereby designate the following individual as my alternate Health Care Representative:
Full Name of Alternate Health Care Representative: ______________
Relationship to Principal: _____________________________________
Address of Alternate Health Care Representative: ________________
City, State, Zip: ______________________________________________
Alternate Health Care Representative's Telephone Number: _________
Part 3: Health Care Decisions
My Health Care Representative is authorized to make all health care decisions on my behalf, including but not limited to, decisions regarding medical treatment, surgical interventions, and end-of-life care, consistent with the desires I have expressed herein or otherwise communicated.
In the absence of specific instructions from me, my Health Care Representative is to make decisions based on what they believe to be in my best interests, considering my personal values to the extent known to them.
Part 4: Specific Limitations
If there are specific treatments or procedures I do not want under any circumstances, they are listed here:
________________________________________________________________
Part 5: Organ Donation
Upon my death, I wish to donate my organs.
- Only the following organs or parts: ___________________________
- Any needed organs or parts for transplantation.
- I do not wish to donate any organs or parts.
Part 6: Signature
This document is effective upon my signature and remains in effect until revoked by me or upon my death.
________________________________ ____________________________
Signature of Principal Date
Part 7: Witness Declaration
This Medical Power of Attorney was signed in my presence by _____________________ (Principal's name) who appears to be of sound mind and under no duress or undue influence. I am not related to the Principal by blood, marriage, or adoption, and, to the best of my knowledge, I am not entitled to any part of the estate of the Principal under a will now existing or by operation of law.
________________________________ ____________________________
Signature of Witness 1 Date
________________________________ ____________________________
Signature of Witness 2 Date
File Breakdown
| Fact Name | Description |
|---|---|
| Definition | A New Jersey Medical Power of Attorney allows individuals to appoint someone to make healthcare decisions on their behalf if they become unable to do so. |
| Governing Law | This form is governed by the New Jersey Statutes Annotated (N.J.S.A.) 52:27D-1 et seq. |
| Eligibility | Any competent adult aged 18 or older can create a Medical Power of Attorney in New Jersey. |
| Agent Requirements | The appointed agent must be at least 18 years old and cannot be the individual’s healthcare provider or an employee of the healthcare provider. |
| Durability | The Medical Power of Attorney remains effective even if the individual becomes incapacitated, unless revoked. |
| Revocation | The principal can revoke the Medical Power of Attorney at any time, as long as they are still competent to do so. |
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