Connecticut Medical Power of Attorney Form

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The Connecticut Medical Power of Attorney, otherwise known as the “Appointment of Health Care Representative”, is conducive to those who would like to grant a third (3rd) party the authority to make healthcare decisions on their behalf in the event of their incapacitation. The form is relatively simple, only requiring that the party bestowing the powers supply it with the name of their appointee (and of an alternative agent if desired), the date of the document’s execution, and their signature (signing requirements listed below).

Other Versions

Connecticut Medical Power of Attorney – Version 1

Download: Adobe PDF

 

 

 


Yale New Haven Health Version (also available in Spanish/en Español)

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