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Free Vermont Medical Power of Attorney Form

A Vermont medical power of attorney is the agent section of the state's advance directive under 18 V.S.A. chapter 231. Build yours with our guided form, including Vermont's remote-witness option.

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  • E-sign included

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What Is a Medical Power of Attorney in Vermont?

Vermont uses a single advance directive to appoint a health care agent and record your wishes, under 18 V.S.A. chapter 231. An adult with capacity can sign one at any time.

Vermont Requirements Under 18 V.S.A. § 9703

Section 9703 sets out how to execute the directive.

Date It and Sign It

Your Vermont medical power of attorney must be dated and signed by you. If you are physically unable to sign, another person may sign in your presence at your express direction.

Two Adult Witnesses

Two or more witnesses at least 18 years old sign. They affirm you appeared to understand the document and were free from duress or undue influence.

Providers Can Witness

Vermont expressly allows a health care provider to serve as a witness.

Digital Signatures

Since 2024, Vermont allows digital signatures on the directive.

Can a Witness Sign Remotely in Vermont?

Yes, since April 1, 2024, if three conditions are met:

  • You and the remote witness know each other
  • You communicate through a live, interactive audio-video connection or by telephone, and the witness attests you understood the document and were free from duress
  • Your directive lists the remote witness’s name, contact information, and relationship to you

The phone option is unusual. It makes a Vermont medical power of attorney easier to complete if a trusted friend lives far away.

Hospital and Nursing Home Signers

If you are being admitted to or living in a nursing home or residential care facility, or are a hospital patient, Vermont requires someone to explain the directive to you. That person may also serve as one of your witnesses.

How to Sign Your Vermont Medical Power of Attorney

Move through your Vermont medical power of attorney form in this order:

  1. Name your health care agent and an alternate.
  2. Write your treatment wishes and goals.
  3. Choose two adult witnesses, in person or remote.
  4. For a remote witness, add their name, contact details, and relationship to you.
  5. Date and sign the directive, then collect both witness signatures.
  6. Give copies to your agent and your clinicians.

What to Include in Your Vermont Form

Section 9703 focuses on how the directive is signed rather than a fixed layout. A complete advance directive usually includes:

  • Your health care agent and alternates
  • Your treatment preferences, including life-sustaining treatment
  • Remote witness details, if you used one
  • Signatures and affirmations from your witnesses
  • Any explanation statement required if you sign in a hospital or care facility

Vermont also lets you add a provision allowing your agent to authorize or withhold care over your objection if you lack capacity. That provision is valid only if you name the agent, the agent accepts in writing, and a clinician signs and affirms it.