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Free West Virginia Medical Power of Attorney Form

A West Virginia medical power of attorney names your representative under the West Virginia Health Care Decisions Act. Our guided form walks you through the state's witness-and-notary signing rule.

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What Is a Medical Power of Attorney in West Virginia?

West Virginia’s Health Care Decisions Act, W. Va. Code Chapter 16, Article 30, uses the name “medical power of attorney” directly. You can sign one on its own or as a combined medical power of attorney and living will.

West Virginia Requirements Under § 16-30-4

Section 16-30-4 lists five requirements.

The Five Steps

Your West Virginia medical power of attorney must be:

  • In writing
  • Signed by you, or by another person in your presence at your express direction
  • Dated
  • Signed in the presence of two or more witnesses who are at least 18
  • Signed and attested by those witnesses, whose signatures and attestations are acknowledged before a notary public

Who Cannot Witness

A witness may not be the person who signed on your behalf at your direction. A witness also may not be related to you by blood or marriage. The statute lists further disqualifications, so review them before choosing witnesses.

Does a West Virginia Medical Power of Attorney Need a Notary?

Yes, and the notary’s job is specific. In West Virginia, the notary acknowledges the witnesses’ signatures and attestations, not just yours. That means your two witnesses and the notary should all be present when you sign your West Virginia medical power of attorney.

A form written for another state may not include this step. Use a form built for West Virginia’s requirements.

Consider the Combined Document

West Virginia lets you sign a combined medical power of attorney and living will. One document can name your representative and state your end-of-life wishes, which keeps everything in a single place.

How to Sign Your West Virginia Medical Power of Attorney

Complete your West Virginia medical power of attorney form in this order:

  1. Name your representative and a successor.
  2. Add treatment instructions, or combine the document with a living will.
  3. Arrange for two adult witnesses and a notary to be present together.
  4. Date and sign the document in front of the witnesses.
  5. Have the witnesses sign and attest, then have the notary acknowledge their signatures.
  6. Give copies to your representative and your doctors.

What to Include in Your West Virginia Form

A complete West Virginia document usually includes:

  • Your representative and a successor representative
  • Any limits on the representative’s authority
  • Treatment instructions, or a combined living will section
  • Signature and date lines for you
  • Witness signatures and attestations, with the notary’s acknowledgment

Check each witness against the statute’s disqualification list before signing day. Bringing everyone together at a bank, law office, or care facility with a notary on staff can make the appointment simpler.

Keep the original where your representative can reach it quickly.