Montana Medical Power of Attorney Form

If you would like to assign a healthcare professional to make decisions related to your health on your behalf in the case of you not being able to make those decisions yourself int he the State of Montana, the Montana Medical Power of Attorney Form has to be completed and submitted.

Extracted Text for Proper Search

DURABLE POWER OF ATTORNEY 	
FOR HEALTH CARE AND MEDICAL TREATMENT 
 
I , _________________________ of the City of ______________________, 
State of Montana, do hereby make, constitute, nominate and appoint 
____________________________presently  residing in________________, 
County, State of Montana,  as my true and lawful attorney-in-fact to act for 
me andin my place and stead for the purpose of making any and all decisions 
regarding my health and, medical care  and treatment at any time that I may 
be, by reason of physical, mental disability, incompetency or incapacity, 
incapable of making decisions on my behalf. 
 
1.  I grant said attorney-in-fact complete  and full authority to do and perform 
all andevery act and thing whatsoever  requisite, proper and necessary to be 
done in the exercise of the rights herein  granted, as fully for all intents and 
purposes as I mightor could do if personally present and able with full power 
of substitution or revocation, hereby ra tifying and confirming all that said 
attorney-in-fact shall lawfully do or cause to be done by virtue of this power 
of attorney and the rights and powers granted herein. 
 
2.  If, at any time, I am unable to make  or communicate decisions concerning 
my medical care and treat ment, by virtue of physical, mental or emotional 
disability,incompetency, incapacity, illne ss or otherwise, my said attorney-
in-fact shall have the authority to ma ke all health care decisions and all 
medical care and treatment decisions for me and on my  behalf, including 
consenting or refusing to consent toa ny care, treatment, service or procedure 
to maintain, diagnose or treat  my mentalor physical condition. 
 
 3. In the absence of my ability to give di rections regarding my health care, it 
is my intention that my said attorney-i n-fact shall exercise this specific grant 
of authority and that such exercise shall be honored by my 
family,physicians, nurses, and any other health care provide r(s) or facility in 
which or by which I may be  treated, as afinal expression of my legal rights. 
 
4. This power of attorney is durable a nd will continue to be effective if I 
become disabled, incapacitated, or incompetent. 
 
5 . This durable power of attorney is effe ctive in any state that I may seek or 
receive medical-treatme nt and health care.

6. I specifically direct all health care providers, including physicians, nurses, 
therapists and medical and hospital staff to follow the directions of my 
attorney-in-fact and such  decisions are superior to and shall take precedence 
over any decisions made by an y member of my family. 
 
7. The rights, powers, and authority of said attorney-in-fact herein granted 
shall commence and be in full fo rce and effect immediately. 
 
8. If any agent named by me dies, become s incompetent, resigns or refuses 
to accept the office of agent, I name  the following persons (each to act alone 
and successively, in the order named) as successor(s) to the agent: 
 
A. ____________________________ _________________________ 
 
B. _____________________________________________________ 
 
9. Special instructions: On the following  lines I give special instructions 
limiting or extending the power s granted to my agent. 
________________________________ _____________________________ 
 
_____________________________________________________________ 
 
_____________________________________________________________ 
 
10. I hereby designate _______ __________ to determine whether I am 
unable to make or communicate decisi ons concerning my medical care and 
treatment by virtue of my physical , mental, or emotional disability, 
incompetency, incapacity, illness or othe rwise. This determination will be 
provided in writing and attached to this Durable Power of Attorney For 
Health Care and Medical Treatment. 
 
Dated this __________ day of  _____________, ___________. 
 
Signature of Principal:  
 
____________________________________________ 
 
Social Security Number: ___________ - ________ - __________.

State of Montana 
County of ___________________________________ 
 
Subscribed, sworn to and acknowle dged before me this __________day 
 
of __________________ _____, ___________. 
 
(Notarial Seal) 
 
 
 
___________________________________ 
Notary Public For the State of Montana 
Residing at ________________________ 
My commission expires: _____________