Hawaii Medical Power of Attorney
This Medical Power of Attorney is created to comply with the laws of the State of Hawaii.
This document allows you to appoint someone to make medical decisions on your behalf if you are unable to do so.
Please fill in the following information:
- Your Name: ____________________________
- Your Address: ________________________
- Your Phone Number: ___________________
- Agent's Name: _________________________
- Agent's Address: ______________________
- Agent's Phone Number: _________________
I, [Your Name], hereby appoint [Agent's Name] as my healthcare agent to make medical decisions on my behalf if I am unable to communicate my wishes regarding medical treatment.
This authority includes, but is not limited to:
- Making decisions about surgery or other medical procedures.
- Agreeing or refusing to agree to medical treatments.
- Accessing my medical records to make informed decisions.
This Medical Power of Attorney will remain in effect until revoked by me in writing.
Signed on this ____ day of ______________, 20__.
Your Signature: _________________________
Witness Signature: ______________________
Witness Name: _________________________