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Free Minnesota Medical Power of Attorney Form

A Minnesota medical power of attorney is part of a health care directive, where you appoint a health care agent. Answer our questions to build yours and pick how to verify your signature.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

Choose the state or form type you need to start.

2

Fill In Your Details

Answer a few simple questions to customize your form.

3

Get Your Form

Download or print your custom document in PDF or Word.

What Is a Medical Power of Attorney in Minnesota?

Minnesota calls this a health care power of attorney within a health care directive, governed by Minnesota Statutes chapter 145C. A directive can appoint an agent, give health care instructions, or both.

What Minnesota Requires for a Health Care Directive

Section 145C.03 lists six requirements for a legally sufficient directive.

The Six Basics

Your directive must:

  • Be in writing
  • Be dated
  • State your name
  • Be signed by you, or by someone you authorize, while you have capacity
  • Have the signature verified by a notary public or by witnesses
  • Include a health care instruction, a health care power of attorney, or both

Two Witnesses or a Notary

The Minnesota Department of Health explains that your signature is verified by a notary public or two witnesses. You do not need both.

Who Cannot Verify It

Your agent or alternate agent cannot witness or notarize your Minnesota medical power of attorney. At least one witness cannot be a provider giving you direct care, or that provider’s employee, on the day you sign.

Can a Clinic Employee Notarize a Minnesota Medical Power of Attorney?

Yes. Minnesota expressly allows a notary who works for a health care provider giving you direct care. That makes it easy to finish the document during a clinic visit.

Witnesses are treated differently. If you go that route, only one of your two witnesses may be a direct-care provider or employee. The state’s suggested form spells out both options side by side.

Who Can Serve as Your Agent

A health care provider attending you when you sign, or when decisions are needed, generally cannot be your agent. The exception covers people related to you by blood, marriage, registered domestic partnership, or adoption, or cases where your directive specifies otherwise.

How to Sign Your Minnesota Medical Power of Attorney

Move through these steps to finish your Minnesota medical power of attorney form:

  1. Write your name and the date.
  2. Appoint your health care agent and any alternates.
  3. Add health care instructions, if you want them.
  4. Choose a notary or two witnesses, keeping your agents out of both roles.
  5. Sign, or have an authorized person sign for you.
  6. Give copies to your agent and your health care providers.

What to Include in Your Minnesota Form

You do not have to use a form, according to the Minnesota Department of Health. Section 145C.16 offers a suggested one. A practical Minnesota medical power of attorney covers:

  • Your agent and alternates
  • Treatment instructions and values
  • Any conditions on when your agent may act

Minnesota honors directives made in other states if they meet that state’s law or Minnesota’s. If you think a provider or health plan ignored your directive, the Department of Health lists where to file a complaint.