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Free Nebraska Medical Power of Attorney Form

A Nebraska medical power of attorney names the attorney in fact who makes health care decisions if you are incapable. Our step-by-step questionnaire covers the details the state requires.

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  • E-sign included

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What Is a Medical Power of Attorney in Nebraska?

Nebraska calls this a power of attorney for health care, governed by Neb. Rev. Stat. §§ 30-3401 to 30-3432. It names an attorney in fact, and optionally a successor, to make health care decisions if you become incapable.

Nebraska Requirements for a Health Care Power of Attorney

The Nebraska Department of Health and Human Services summarizes what the document must contain.

Required Contents

Your Nebraska medical power of attorney must:

  • Be in writing
  • Identify you, your attorney in fact, and any successor
  • Specifically authorize your attorney in fact to make health care decisions if you are incapable
  • Show the date you signed it

Two Witnesses or a Notary

You sign in front of two adult witnesses, each of whom sees you sign and date it or hears you acknowledge it. The Nebraska Supreme Court’s self-help form offers a notary acknowledgment as the alternative.

How Successors Work

A successor serves when your original attorney in fact is not reasonably available, or is unable or unwilling. If the original later becomes available and willing again, their authority resumes.

Who Can Witness a Nebraska Medical Power of Attorney?

Choose witnesses who are not your attorney in fact. The court’s form has each witness confirm that neither of them, nor your attending physician, is the person appointed.

The witnesses also confirm you signed in their presence and appeared of sound mind and free of duress or undue influence. Picking disinterested adults keeps your Nebraska medical power of attorney on solid ground.

Read the Acknowledgment Paragraph

The Nebraska court form asks you to confirm you understand the document lets another person make life and death decisions for you. It also reminds you that you can revoke it by notifying your attorney in fact, your physician, or your facility. Read that paragraph carefully before signing.

How to Sign Your Nebraska Medical Power of Attorney

Finish your Nebraska medical power of attorney form using these steps:

  1. Identify yourself, your attorney in fact, and a successor.
  2. Include a specific grant of authority to make health care decisions if you are incapable.
  3. Add optional instructions on life-sustaining treatment or nutrition and hydration.
  4. Date the document.
  5. Sign in front of two adult witnesses, or before a notary.
  6. Share copies with your attorney in fact, successor, and doctors.

What to Include in Your Nebraska Form

The Nebraska Supreme Court publishes a self-help form, DC 6:13, that lets you add optional instructions in three areas:

  • General instructions or limitations for your attorney in fact
  • Instructions on life-sustaining treatment, such as respirators
  • Instructions on artificially administered nutrition and hydration

Nebraska presumes every adult is competent to sign a power of attorney for health care unless a court has found otherwise or appointed a guardian.