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Durable Power of Attorney for Health Care

Establishing advance directives regarding future health care decisions can ensure that a person’s wishes are met and can also relieve families from having to make difficult decisions at a time of great stress. The Missouri Bar has developed and makes available as a public service a “Durable Power of Attorney for Health Care and Health Care Directive” for use by the general public.  This form may be downloaded and/or photocopied as needed.  There is no copyright on this publication.

The DPA and its accompanying HIPAA form (available in a separate link below) are now fillable and saveable PDF forms (sometimes called “interactive” forms). Once you have filled in the forms, simply save them to your computer. You can open them later to finish or to make changes.

The fillable forms require Adobe Acrobat Reader 8.0 or higher to complete, save and print. If you do not have the Adobe Acrobat Reader, you can download it for free by clicking here.

FILLABLE FORMS:

Be sure to read the beginning instructions and final instructions (click on the red stars) and the specific instructions (click on the green “text notes”) as you fill out the forms. Also, be sure to initial those areas where marked after you have printed the form (the initial fields are not “fillable”).

The Missouri Bar Durable Power of Attorney for Health Care and Health Care Directive (with a link to FAQs and instructions)

HIPAA Privacy Authorization Form (with a link to instructions)

NON-FILLABLE FORMS:

Or you may download the entire packet and complete by hand. (Complete DPA/HIPAA Packet – non-fillable forms, 16 pages)

SPANISH VERSION (PODER LEGAL PERMANENTE PARA EL CUIDADO DE LA SALUD Y DIRECTIVAS PARA EL CUIDADO DE LA SALUD):

The entire packet is now also available in Spanish. (Complete Spanish Version of DPA/HIPAA Packet – non-fillable forms, 16 pages)

PRINTED COPIES

The 16-page DPA/HIPAA booklet includes frequently asked questions and answers, instructions and forms regarding health care decisions. If you would like printed copies of this booklet free of charge, please click here to submit your order. There is a maximum of 5 per order for individuals and a maximum of 50 per month for businesses (hospitals, health clinics, etc.).

 

NOTE: On May 1, 2012, a policy was adopted that limits the number of Durable Power of Attorney for Health Care and Health Care Directive – 50 per month – that can be ordered by a business (e.g. nursing homes, hospitals, etc.). This policy became necessary because the large, multiple orders from such businesses depleted our supply to the point that we were unable to provide the DPAs to the many individuals requesting this publication.

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