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Free Virginia Medical Power of Attorney Form

A Virginia medical power of attorney appoints an agent inside an advance directive under the Health Care Decisions Act. Our guided form follows Virginia's suggested advance medical directive layout.

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  • E-sign included

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What Is a Medical Power of Attorney in Virginia?

Virginia appoints a health care agent through a written advance directive under the Health Care Decisions Act, Va. Code §§ 54.1-2981 to 54.1-2993.1. The same document can include treatment instructions and anatomical gift wishes.

Virginia Requirements Under § 54.1-2983

Section 54.1-2983 sets the rules for signing.

Two Subscribing Witnesses

Any adult capable of making an informed decision may sign a written advance directive. You sign your Virginia medical power of attorney in the presence of two subscribing witnesses.

Notify Your Physician

It is your responsibility to let your attending physician know you have an advance directive. If you cannot, anyone else may notify the physician.

How Capacity Is Decided

Before your agent can act, your attending physician must certify in writing that you cannot make an informed decision. A capacity reviewer usually must certify it too, unless you are unconscious or profoundly impaired.

Can a Family Member Witness a Virginia Medical Power of Attorney?

Yes. Virginia defines a witness as any person over 18, including your spouse or a blood relative. Employees of health care facilities and physician’s offices may also serve, as long as they act in good faith.

That makes it easier to find witnesses for a Virginia medical power of attorney. You still need two, and they must sign in your presence.

Divorce Filings Revoke Your Agent

Since 2024, filing for divorce or annulment between you and your agent revokes the agent’s authority. So does filing a petition for custody or visitation of a child you share. Name a successor agent so someone can step in.

How to Sign Your Virginia Medical Power of Attorney

Complete your Virginia medical power of attorney form using this list:

  1. Appoint your primary agent and a successor agent in Option I.
  2. Cross out or add powers in Option II to fit your wishes.
  3. Complete any health care or end-of-life instructions.
  4. Sign in the presence of two adult witnesses, and have them sign.
  5. Tell your attending physician about the directive.
  6. Consider submitting it to the state’s Advance Health Care Planning Registry.

What to Include in Your Virginia Form

Virginia’s suggested form in § 54.1-2984 may, but need not, be used. It is organized in options you can select or cross out:

  • Option I: appointment of your agent and successor
  • Option II: powers of your agent, including admission decisions and visitation
  • Option III: specific health care instructions
  • Option IV: end-of-life instructions, including a pregnancy option
  • Option V: an agent for anatomical gifts

Some powers, such as letting your agent act over your later protest, need a physician’s or licensed clinical psychologist’s attestation when you sign. Virginia also lets you register your directive with the Advance Health Care Planning Registry.