COLORADO MEDICAL DURABLE POWER OF ATTORNEY
(“Healthcare Power of Attorney”)
TABLE OF CONTENTS
I. Document Header......................................................... 2
II. Definitions............................................................. 3
III. Operative Provisions................................................... 5
A. Appointment & Scope of Authority................................ 5
B. End-of-Life Instructions........................................ 7
C. HIPAA Authorization............................................. 8
D. Effectiveness, Duration & Revocation............................ 9
IV. Representations & Warranties........................................... 10
V. Covenants & Restrictions............................................... 10
VI. Default & Remedies..................................................... 11
VII. Risk Allocation....................................................... 12
VIII. Dispute Resolution................................................... 13
IX. General Provisions..................................................... 14
X. Execution Block........................................................ 16
I. DOCUMENT HEADER
This Medical Durable Power of Attorney (“Agreement”) is executed as of [EFFECTIVE DATE] (“Effective Date”) by and between the undersigned principal [PRINCIPAL LEGAL NAME], residing at [ADDRESS] (“Principal”), and [AGENT LEGAL NAME], residing at [ADDRESS] (“Agent”).
RECITALS
A. Pursuant to Colo. Rev. Stat. § 15-14-506 (2023) and related provisions, a competent adult may designate an agent to make or communicate healthcare decisions when the adult lacks decisional capacity.
B. Principal desires to appoint Agent as the Principal’s lawful attorney-in-fact for healthcare decisions, with all powers granted herein, to ensure that Principal’s healthcare preferences are honored.
C. No consideration is required other than the mutual promises herein.
Governed Law: State of Colorado healthcare law.
Forum Selection: The probate court of the county in Colorado in which the Principal then resides.
Arbitration: Not applicable.
Jury Waiver: Not applicable.
Injunctive Relief: Preserved for enforcement of healthcare directives.
Indemnification: Agent protected for good-faith acts.
Liability Cap: Agent liable only for acts or omissions outside a good-faith standard.
[// GUIDANCE: Colorado does not mandate notarization or witnessing for an MDPOA, but both are strongly recommended to avoid challenges.]
II. DEFINITIONS
For purposes of this Agreement, the following capitalized terms shall have the meanings set forth below:
“Advance Directive” – A written instruction, including this Agreement, recognized under Colorado law, relating to the provision of future healthcare when the Principal lacks decisional capacity.
“Agent” – The individual appointed under Section 3.1 to make Healthcare Decisions on behalf of the Principal.
“Alternate Agent” – The individual(s) named in Section 3.4 to serve if the Agent is unable, unwilling, or ineligible to serve.
“Decisional Capacity” – The ability to provide informed consent to or refusal of medical treatment, as determined under Colo. Rev. Stat. § 15-14-505(8).
“Good Faith” – Honesty in fact and the observance of reasonable standards of health-care decision making under the circumstances.
“Healthcare Decision” – Any consent, refusal, withdrawal, or selection of treatment, service, or procedure to maintain, diagnose, treat, or affect an individual’s physical or mental condition.
“HIPAA” – The Health Insurance Portability and Accountability Act of 1996 and regulations promulgated thereunder, including 45 C.F.R. §§ 164.502 & 164.508.
“Principal” – The individual executing this Agreement and on whose behalf the Agent acts.
III. OPERATIVE PROVISIONS
3.1 Appointment and Grant of Authority
3.1.1 Principal hereby appoints [AGENT LEGAL NAME] as Agent with full authority to make any and all Healthcare Decisions for the Principal, to the same extent the Principal could make such decisions if competent, subject to the limitations expressly set forth herein.
3.1.2 The authority granted includes, without limitation, the powers to:
a. Consent to, refuse, or withdraw any medical treatment, diagnostic test, surgical procedure, life-sustaining intervention, medication, or nutrition and hydration plan;
b. Select or discharge healthcare providers and institutions;
c. Have access to, request, and receive medical information and records, and to disclose the same as necessary;
d. Authorize admission to or discharge from hospitals, nursing homes, hospice, assisted-living, or similar facilities;
e. Execute documents required by any hospital, facility, or healthcare provider;
f. Apply for public or private health-care benefits; and
g. Take any other action incidental to or reasonably necessary for the foregoing.
3.2 Decision-Making Standard
In exercising the authority herein, Agent shall:
a. Act in Good Faith;
b. Follow the Principal’s known wishes, including those expressed in Section 3.2.1 (Statement of Intent) and Section 3.3 (End-of-Life Instructions); and
c. If wishes are unknown, act in the Principal’s best interests, consistent with Colo. Rev. Stat. § 15-14-507.
3.3 End-of-Life Instructions
[SELECT ONE OR CUSTOMIZE]
☐ (Comfort-Focused Care) If I am terminally ill or permanently unconscious, I direct my Agent to withhold or withdraw life-sustaining treatment except as needed for comfort.
☐ (Life-Prolonging Care) I desire all life-sustaining treatment reasonably available unless such treatment is futile or excessively burdensome.
☐ (Custom) ___________
[// GUIDANCE: Use precise language; avoid ambiguous phrases such as “heroic measures.” End-of-life directives harmonize with Colorado’s Medical Treatment Decision Act, Colo. Rev. Stat. § 15-18-101 et seq.]
3.4 Nomination of Alternate Agent(s)
If the primary Agent is unavailable, unwilling, or legally disqualified, authority shall pass in the following order:
1. [ALTERNATE AGENT #1 NAME]
2. [ALTERNATE AGENT #2 NAME]
3.5 HIPAA Authorization
Principal hereby authorizes any Covered Entity (as defined in 45 C.F.R. § 160.103) to disclose Protected Health Information to the Agent to the same extent as the Principal, effective upon execution and surviving the Principal’s death to the extent permitted by law.
3.6 Effectiveness & Duration
3.6.1 This Agreement becomes effective upon execution and continues in effect notwithstanding the Principal’s subsequent incapacity.
3.6.2 It shall remain in force until revoked pursuant to Section 3.7 or the Principal’s death.
3.7 Revocation
Principal may revoke this Agreement in whole or in part at any time by:
a. Signing and dating a written revocation;
b. Verbally expressing intent to revoke in the presence of a witness 18 years or older who contemporaneously documents the revocation; or
c. Executing a new medical durable power of attorney.
Any revocation is effective upon communication to the Agent and the attending physician.
IV. REPRESENTATIONS & WARRANTIES
4.1 Principal represents that the Principal is at least 18 years old, of sound mind, and under no duress or undue influence.
4.2 Agent represents (by signing the Acceptance below) that Agent:
a. Is legally competent and at least 18 years old;
b. Accepts the appointment and understands the duties imposed; and
c. Will act in Good Faith and consistent with Principal’s wishes.
V. COVENANTS & RESTRICTIONS
5.1 Agent shall:
a. Consult with healthcare professionals to obtain material information;
b. Keep reasonably contemporaneous records of decisions made;
c. Provide timely notice of major Healthcare Decisions to interested family members, unless the Principal has directed otherwise herein.
5.2 Agent shall not:
a. Delegate decision-making authority except to an Alternate Agent as provided;
b. Receive compensation other than reimbursement of out-of-pocket expenses without court approval.
VI. DEFAULT & REMEDIES
6.1 Events of Default
a. Agent’s breach of Good Faith;
b. Agent’s incapacity, resignation, or death;
c. Judicial finding of Agent misconduct.
6.2 Remedies
a. Automatic elevation of the next-named Alternate Agent;
b. Petition to the probate court for removal and appointment of a guardian;
c. Injunctive relief to prevent or compel specific healthcare actions.
6.3 Attorneys’ Fees
The prevailing party in any action to enforce this Agreement shall be entitled to reasonable attorneys’ fees and costs.
VII. RISK ALLOCATION
7.1 Indemnification
To the fullest extent permitted by law, the Principal shall indemnify and hold harmless the Agent for all claims, liabilities, and expenses arising from Healthcare Decisions made in Good Faith.
7.2 Limitation of Liability
Agent shall not be liable for any act or omission undertaken in Good Faith and in substantial compliance with this Agreement and applicable law.
7.3 Insurance
Nothing herein requires the Agent to obtain liability insurance; however, the Agent may do so and charge premiums to Principal’s estate.
VIII. DISPUTE RESOLUTION
8.1 Governing Law
This Agreement and any dispute hereunder shall be governed by the laws of the State of Colorado.
8.2 Forum Selection
Exclusive jurisdiction and venue shall lie in the probate court of the county in which the Principal then resides.
8.3 Arbitration & Jury Trial
Arbitration is not available. The parties retain all rights to non-jury judicial resolution unless waived by separate written instrument.
8.4 Injunctive Relief
Nothing herein limits the right of any interested person to seek injunctive relief to enforce the Principal’s healthcare directives.
IX. GENERAL PROVISIONS
9.1 Amendment
This Agreement may be amended only by a written instrument signed by the Principal while having Decisional Capacity.
9.2 Assignment
The Agent’s authority is personal and non-assignable, except to Alternate Agents as provided herein.
9.3 Successors & Assigns
This Agreement binds and benefits the Principal’s heirs, devisees, personal representatives, and permitted assigns.
9.4 Severability
If any provision is held invalid, the remainder shall be enforced to the maximum extent permitted by law.
9.5 Integration
This Agreement constitutes the entire medical durable power of attorney of the Principal, superseding all prior inconsistent directives.
9.6 Counterparts & Electronic Signatures
This Agreement may be executed in counterparts, each of which is deemed an original, and signatures transmitted electronically shall be deemed originals.
X. EXECUTION BLOCK
10.1 Principal
[PRINCIPAL LEGAL NAME], Principal
Date: ___
10.2 Agent Acceptance
I, [AGENT LEGAL NAME], accept the appointment as Agent and agree to act in accordance with this Agreement and Colorado law.
[AGENT LEGAL NAME], Agent
Date: ___
10.3 Alternate Agent(s) Acceptance (if any)
[ALTERNATE AGENT #1 NAME], Alternate Agent
Date: ___
[ALTERNATE AGENT #2 NAME], Alternate Agent
Date: ___
10.4 Notary Acknowledgment (Optional but Recommended)
State of Colorado )
County of __ ) ss.
Subscribed, sworn to, and acknowledged before me by [PRINCIPAL LEGAL NAME], this ___ day of _, 20.
Notary Public
My Commission Expires: _____
10.5 Witness Attestation (Optional)
We declare that the Principal is personally known to us, signed or acknowledged this instrument in our presence, and appears to be of sound mind and under no duress.
- ___ Date: ______
- ___ Date: ______
[// GUIDANCE:
1. Attach copies to the Principal’s electronic health record, primary physician, and each named Agent.
2. Encourage clients to carry a wallet card noting the existence of this MDPOA.
3. Review regularly, particularly after major life events or statutory changes.]