Free Illinois Medical Power of Attorney Form | PDF

Illinois Medical Power of Attorney Form

An Illinois Medical Power of Attorney is a precautionary measure taken to delegate certain healthcare decisions to an agent if you are ever in a position where you cannot mentally function. Mostly, individuals will assign a family member (spouse, son/daughter, relative) or a trusted friend to participate in the arrangement.

Last updated October 23rd, 2024

An Illinois Medical Power of Attorney is a precautionary measure taken to delegate certain healthcare decisions to an agent if you are ever in a position where you cannot mentally function. Mostly, individuals will assign a family member (spouse, son/daughter, relative) or a trusted friend to participate in the arrangement.

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Other Versions (6)

Advocate Health Care Version

Download: Adobe PDF

 

 

 


HSHS St. Elizabeth’s Hospital Version

Download: Adobe PDF

 

 

 


Memorial Health System Version

Download: Adobe PDF

 

 

 


Northwestern Medicine Version

Download: Adobe PDF

 

 

 


Southern Illinois Healthcare Version

Download: Adobe PDF

 

 

 


Spanish/Español Version

Download: Adobe PDF

 

 

 

Additional Resources

Illinois Department of Public Health Medical Power of Attorney Information

Related Forms (7)

Advance Directive (Medical POA & Living Will)

Download: Adobe PDF

 

 

 


Advance Directive Wallet Cards

Download: Adobe PDF

 

 

 


Declaration for Mental Health Treatment

Download: Adobe PDF
Spanish Version: Adobe PDF
Laws755 ILCS 43

 

 


Do-Not-Resuscitate (DNR) Order Form

Download: Adobe PDF
Spanish Version: Adobe PDF

 

 


Durable (Financial) Power of Attorney

Download: Adobe PDF, MS Word (.docx)

 

 

 


Practitioner Orders for Life-Sustaining Treatment (POLST) Form

Download: Adobe PDF
Spanish Version: Adobe PDF

 

 


Statement of Illinois Law on Advance Directives

Download: Adobe PDF

 

 

 

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