Healthcare Power of Attorney - Colorado

COLORADO MEDICAL DURABLE POWER OF ATTORNEY

Important Information

This document lets an adult appoint an agent to make medical-treatment
decisions if the adult lacks decisional capacity. It does not replace a
Colorado living will or CPR directive.

Colorado's Patient Autonomy Act does not require witnesses, notarization, or
the agent's signed acceptance for this medical appointment. Discuss the form
with your agent, physician, family, and a Colorado attorney and give copies to
the people and institutions that may need it.

1. Principal

Name: [FULL LEGAL NAME]

Date of birth: [__/__/____]

Address: [ADDRESS]

Telephone: [TELEPHONE]

Email: [EMAIL]

2. Appointment of Medical Agent

I appoint the following adult as my agent for medical-treatment decisions:

Name: [PRIMARY AGENT NAME]

Address: [ADDRESS]

Telephone: [TELEPHONE]

Email: [EMAIL]

First Alternate Agent

If my primary agent is unable or unwilling to serve, I appoint:

Name: [FIRST ALTERNATE NAME]

Address: [ADDRESS]

Telephone: [TELEPHONE]

Email: [EMAIL]

Second Alternate Agent

If neither person named above is able and willing to serve, I appoint:

Name: [SECOND ALTERNATE NAME]

Address: [ADDRESS]

Telephone: [TELEPHONE]

Email: [EMAIL]

3. Authority and Decision Standard

If I lack decisional capacity, my agent may consent to or refuse medical
treatment, including artificial nourishment and hydration, to the same extent I
could decide for myself. My agent has the same right of access to my medical
records that I have and must confer with my attending physician about my
condition.

My agent must follow the directives, conditions, and limitations in this
document and my other known wishes. If my wishes are not known, my agent must
act according to my best interests as determined by my agent.

I retain the right to consent to or refuse treatment while I have decisional
capacity. My agent may not consent to or refuse treatment over my objection.

4. Directives, Conditions, and Limitations

My instructions and limitations are:

[DESCRIBE OR WRITE "NONE"]

5. Relationship to My Living Will

Select one:

☐ My agent must follow my Colorado living will and may not override it.

☐ My agent may override my Colorado living will as expressly stated here:
[DESCRIBE]

☐ I have not executed a Colorado living will.

6. Anatomical Gift

Select one:

☐ Upon my death, I give any needed organs and tissues.

☐ Upon my death, I give only these organs and tissues: [DESCRIBE]

☐ I do not make an anatomical gift in this document.

Donor signature: ____________________________________

Date: [__/__/____]

7. Spouse as Agent

If I appoint my spouse, a later divorce, dissolution, annulment, or legal
separation automatically revokes that appointment unless I state otherwise
here:

[STATE CONTRARY DIRECTION OR WRITE "NONE"]

Revoking an agent's appointment or an agent's inability or unwillingness to
serve does not revoke the remaining provisions of this document unless this
document states otherwise.

8. Provider Objection and Transfer

A provider or facility must give notice of policies based on moral convictions
or religious beliefs concerning withholding or withdrawing treatment. A
provider or facility that will not follow my agent's decision on that basis must
provide for prompt transfer to a willing provider or facility and continue care
and comfort pending transfer.

9. Principal's Signature

I understand this medical durable power of attorney and sign it voluntarily.

Signature: ____________________________________

Printed name: [FULL LEGAL NAME]

Date: [__/__/____]

Address: [ADDRESS]

Sources and References

• Colorado Revised Statutes 2025 — Title 15 official download page
• Colorado Revised Statutes 2025 — Title 15 HTML
• Colorado Revised Statutes 2025 — Title 15 PDF