The 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. For the most part, individuals will assign a family member (spouse, son/daughter, relative) or a trusted friend to take part in the arrangement. To properly configure this appointment of authority, the principal should take their time and carefully peruse the content of the document, input the necessary data within each portion of the form, and sign it along with at least (1) witnessing party.
Laws
Statute – Powers of Attorney for Health Care (755 ILCS 45/4)
Definition – “Health care agent” means an individual at least eighteen (18) years old designated by the principal to make health care decisions of any type, including, but not limited to, anatomical gift, autopsy, or disposition of remains for and on behalf of the individual (755 ILCS 45/4-4(e-5)).
Statutory Form – 755 ILCS 45/4-10(b)
Signing Requirements – At least one (1) eligible witness who is eighteen (18) years or older must sign the document attesting to the principal’s signature (755 ILCS 45/4-5.1(a)).
Revocation – 755 ILCS 45/4-6
Other Versions (6)
- Advocate Health Care
- HSHS St. Elizabeth’s Hospital
- Memorial Health System
- Northwestern Medicine
- Southern Illinois Healthcare
- Spanish/Español
Download: Adobe PDF
HSHS St. Elizabeth’s Hospital Version
Download: Adobe PDF
Memorial Health System Version
Download: Adobe PDF
Download: Adobe PDF
Southern Illinois Healthcare Version
Download: Adobe PDF
Download: Adobe PDF
Additional Resources
Illinois Department of Public Health – Medical Power of Attorney Information
Related Forms (7)
- Advance Directive (Medical POA & Living Will)
- Advance Directive Wallet Cards
- Declaration for Mental Health Treatment
- Do-Not-Resuscitate (DNR) Order Form
- Durable (Financial) Power of Attorney
- Practitioner Orders for Life-Sustaining Treatment (POLST) Form
- Statement of Illinois Law on Advance Directives
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
Laws: 755 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