Nebraska Medical Power of Attorney Form

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The Nebraska Medical Power of Attorney certifies the legal announcement of a chosen individual to act as a surrogate decison-maker for a person in the event of their possible incapacitation. The supplied form assists a principal party in securing the arranged agency as a precautionary measure should health care issues prevent the ability to communicate their medical preferences. Granted powers of this nature are generally bestowed upon a family member or close friend to provide peace of mind if the declarant should fall ill.

Other Versions (3)

Bryan Medical Center Version

Download: Adobe PDF

 

 

 


Nebraska Catholic Conference Version

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Spanish Version

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Additional Resources

Related Forms (6)

Advance Directive (Medical POA & Living Will)

Download: Adobe PDF

 

 

 


Advance Directive Wallet Card

Download: Adobe PDF

 

 

 


Durable (Financial) Power of Attorney

Download: Adobe PDF

 

 

 


Emergency Treatment Declaration (also available for a Minor)

Download: Adobe PDF
Information: Adobe PDF

 

 

 


Physician’s Do-Not-Resuscitate (DNR) Order

Download: Adobe PDF

 

 

 


Psychiatric Advance Directive

Download: Adobe PDF
Information: Adobe PDF