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Free Wyoming Medical Power of Attorney Form

A Wyoming medical power of attorney names an agent under the Wyoming Health Care Decisions Act. Use our customizable template and choose a notarial officer or two witnesses.

  • Download as PDF and Word
  • E-sign included

How It Works

1

Select Your Template

Choose the state or form type you need to start.

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 Wyoming?

Wyoming calls this a power of attorney for health care under the Wyoming Health Care Decisions Act, W.S. 35-22-401 and following. An adult or an emancipated minor can sign one, and it stays in effect after later incapacity.

Wyoming Requirements Under W.S. 35-22-403

Section 35-22-403 sets the core rules.

Written and Signed

Your Wyoming medical power of attorney must be in writing. You sign it, or another person signs in your presence at your expressed direction.

Notarial Officer or Two Witnesses

The document must either be acknowledged before a notarial officer or be signed by at least two witnesses. Each witness sees you sign or hears you acknowledge it, and makes a sworn declaration.

Facility Staff as Agents

Unless related to you by blood, marriage, or adoption, an owner, operator, or employee of a residential or community care facility where you receive care cannot be your agent.

When Authority Starts

Unless your document says otherwise, your agent’s authority begins only when you are found to lack capacity and ends if you recover.

Who Can Witness a Wyoming Medical Power of Attorney?

Wyoming bars these people from witnessing:

  • A treating health care provider or the provider’s employee
  • The agent named in the document
  • The operator of a community care facility, or an employee of the operator or facility
  • The operator of a residential care facility, or an employee of the operator or facility

Each witness declares under penalty of perjury that they know you to be the principal and that you signed or acknowledged the document in their presence.

Instructions Can Travel Together

Wyoming lets your power of attorney for health care include individual instructions. You can name your agent and record your treatment wishes in one document, so your agent and doctors see both at once.

How to Sign Your Wyoming Medical Power of Attorney

Use these steps to complete your Wyoming medical power of attorney form:

  1. Name your agent and an alternate.
  2. Add any individual instructions about treatment.
  3. Decide whether your agent’s authority starts now or only if you lack capacity.
  4. Choose a notarial officer or two witnesses who are not on the barred list.
  5. Sign, and have witnesses make their sworn declarations if you use them.
  6. Give copies to your agent and your doctors.

What to Include in Your Wyoming Form

A clear Wyoming document usually covers:

  • Your agent and any alternates
  • Individual instructions about treatments you want or refuse
  • When your agent’s authority begins
  • The notarial acknowledgment, or two witness declarations

Your agent can make any health care decision you could have made while you had capacity, unless your Wyoming medical power of attorney limits that authority.