Colorado Medical Power of Attorney
This Medical Power of Attorney is designed to comply with Colorado state laws. It allows you to designate a trusted individual to make medical decisions on your behalf if you become unable to do so.
Principal Information:
Name: ________________________________________
Address: ______________________________________
City: _______________________ State: ___________ Zip: ____________
Date of Birth: __________________________________
Agent Information:
Name: ________________________________________
Address: ______________________________________
City: _______________________ State: ___________ Zip: ____________
Phone Number: _________________________________
Effective Date:
This Medical Power of Attorney becomes effective when I am unable to make my own medical decisions, as determined by my attending physician.
Agent's Authority:
I grant my agent the authority to make decisions regarding my medical treatment, including:
- Choosing healthcare providers
- Consenting to or refusing medical treatment
- Accessing my medical records
- Making decisions about life-sustaining treatment
Limitations on Agent's Authority:
My agent's authority is limited as follows:
____________________________________________________
____________________________________________________
Signature of Principal:
_________________________________________
Date: __________________________________
Witnesses:
This document must be signed in the presence of two witnesses who are not related to the principal or the agent.
Witness 1 Name: _______________________________
Witness 1 Signature: __________________________
Date: ______________________________________
Witness 2 Name: _______________________________
Witness 2 Signature: __________________________
Date: ______________________________________
Notarization (optional):
State of Colorado
County of ____________________________
Subscribed and sworn before me on this ______ day of __________, 20__.
Notary Public: _______________________________
My commission expires: ______________________