Free Illinois Medical Power of Attorney Form

Illinois calls this document a power of attorney for health care, and the state provides a statutory short form in the Illinois Power of Attorney Act. Your agent can make any health care decision you could make, including decisions about life-sustaining treatment.

The key rules sit in 755 ILCS 45/4-5.1 and 4-10, as updated effective January 1, 2016.

One Witness Signs

Every health care power must bear the signature of one witness who is at least 18. The witness confirms they saw you sign, or that you told them the signature is yours.

Who Cannot Witness

Your witness cannot be:

• Your attending physician, advanced practice nurse, physician assistant, dentist, podiatric physician, optometrist, or psychologist, or their relative
• An owner or operator of the facility where you are a patient or resident, or their relative
• Your parent, sibling, or descendant, or the spouse of one, or any such relative of your agent or successor agent
• Your agent or a successor agent

The operator ban reaches a corporate operator’s directors and executive officers. Other staff, such as nurses, social workers, and non-owner chaplains, may witness.

The Notice Comes First

If you use the statutory form, the official notice to the signer must come before the form. Otherwise, no specific format is required.

No, Illinois does not require notarization. The statutory notice tells you directly that there is no need to have the form notarized.

If you write your own Illinois medical power of attorney instead of using the statutory form, the rules are even lighter. You must sign it, name your agent and their powers, and respect the limits on who can serve. It does not need to be witnessed at all.

Here is how to finish your Illinois medical power of attorney form:

1. Read the notice to the signer at the front of the form.
2. Name your agent and any successor agents, who serve one at a time in the order you list them.
3. Check the box for when your agent’s authority starts.
4. Choose an optional statement about life-sustaining treatment and add any limits.
5. Sign and date the form in front of one qualified witness, who then signs.
6. Give copies to your agent, successor agents, and physician, and bring one to the hospital.

An Illinois medical power of attorney on the statutory short form gives your agent broad powers unless you limit them. Under the Illinois law, your agent can:

• Accept, withdraw, or decline treatment, including life-sustaining measures
• Admit you to or discharge you from hospitals and other facilities
• See your medical records as your personal representative under HIPAA
• Visit you on the same terms as a spouse or adult child, despite facility rules
• Make decisions about autopsy, organ donation, and your remains

Your agent is not automatically responsible for your health care expenses. If you check the box nominating your agent as guardian, a court that appoints a guardian must appoint your agent without bond.