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Free New Hampshire Medical Power of Attorney Form

A New Hampshire medical power of attorney is the agent section of the state's advance directive. Complete it with our step-by-step questionnaire and pick one of three signing options.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

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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 New Hampshire?

New Hampshire places the durable power of attorney for health care inside its advance directive under RSA chapter 137-J. The document names an agent to make decisions for an adult who no longer has capacity to make them.

New Hampshire Signing Rules Under RSA 137-J:14

Section 137-J:14 sets out how the advance directive must be signed.

Choose Witnesses or an Official

You sign your New Hampshire medical power of attorney in the presence of one of these:

  • Two or more subscribing witnesses
  • A notary public
  • A justice of the peace

A notary or justice of the peace acknowledges your signature under RSA 456-B.

What Witnesses Affirm

Witnesses affirm that you appeared of sound mind and free from duress. They also affirm that you were aware of the nature of the document and signed it freely and voluntarily.

Signing for Someone Else

If you are physically unable to sign, another person may sign your name in your physical presence and at your express direction.

Who Can Witness a New Hampshire Medical Power of Attorney?

Neither witness can be any of these people at signing:

  • Your agent or surrogate
  • Your spouse or heir at law
  • Anyone entitled to part of your estate under a will, trust, deed, or by law
  • Your attending practitioner, or anyone working under that practitioner’s direction or control

No more than one witness may be your health or residential care provider, or that provider’s employee. Using a notary or justice of the peace for your New Hampshire medical power of attorney sidesteps these limits entirely.

A Justice of the Peace Works Too

New Hampshire is unusual in letting a justice of the peace take the acknowledgment instead of a notary. If a notary is hard to find, a justice of the peace is an equally valid option under RSA 137-J:14.

How to Sign Your New Hampshire Medical Power of Attorney

Here is the order that keeps your New Hampshire medical power of attorney form valid:

  1. Name your health care agent and an alternate.
  2. Add any treatment instructions you want in the same directive.
  3. Decide between two qualified witnesses, a notary, or a justice of the peace.
  4. Check that no witness is your agent, spouse, heir, or attending practitioner.
  5. Sign in their presence, or have someone sign at your express direction.
  6. Hand copies to your agent and each clinician who treats you.

What to Include in Your New Hampshire Form

A complete New Hampshire advance directive usually includes:

  • Your agent and any alternates
  • Any limits on your agent’s authority
  • Treatment instructions, if you want them in the same document
  • The signature block for your chosen witnesses or official

Keep the original somewhere your agent can find it, and give your doctor a copy.