Healthcare Power of Attorney - Delaware

Delaware Health Care Power of Attorney

I appoint the person below to make health care decisions for me when I cannot make them myself. This document is a power of attorney for health care under Delaware's Uniform Health-Care Decisions Act (2023), 16 Del. C. Chapter 25. I am an adult or emancipated minor, and I sign voluntarily.

1. My information

Full legal name: [________________________________]

Date of birth: [__/__/____]

Mailing address: [________________________________]

Telephone or email: [________________________________]

2. My agent

I appoint this person as my agent:

Full legal name: [________________________________]

Relationship to me: [________________________________]

Address: [________________________________]

Telephone: [________________________________] Email: [________________________________]

If my agent resigns, dies, is disqualified, is not reasonably available, or is unwilling or unable to act, I appoint this alternate under 16 Del. C. § 2520:

Full legal name: [________________________________]

Relationship to me: [________________________________]

Address: [________________________________]

Telephone: [________________________________] Email: [________________________________]

If I leave the alternate's name blank, I appoint no alternate. Before naming an agent, I will consider the disqualifications in § 2508(b), including certain nursing home or long-term care facility owners, operators, employees, and contractors and persons subject to specified protective or no-contact orders.

3. Authority and timing

My agent may make health care decisions for me within the authority of 16 Del. C. Chapter 25, including decisions about providers, tests, medication, treatment, artificial nutrition or hydration, and ventilation. My agent must follow my known or reasonably ascertainable directions, goals, preferences, and wishes. If these are unknown, my agent must decide in my best interest under § 2517. This document gives no general authority over my property or finances.

My agent's decision-making power begins and ends as provided by § 2518(a), based on a finding of lack of capacity under § 2504(b) or by a court and any later finding or objection addressed by that section. I retain the right to make my own health care decisions while I have capacity (§ 2503(b)).

My agent may obtain, examine, and share my health care information when authorized by § 2518(b). To permit that information access from the time I appoint my agent, even while I can make my own decisions, I may check this box under § 2518(c):

☐ My agent's information access power under § 2518(b) begins now.

4. My instructions and limits — optional

My agent must follow these specific limits or health care instructions:

[____________________________________________________________]

[____________________________________________________________]

[____________________________________________________________]

If I have a long-term disability requiring routine artificial nutrition, hydration, or mechanical ventilation that I have used without objection, my agent's ability to withhold or withdraw that treatment is limited by § 2519(a). A general grant in this document does not remove those limits.

Special powers — grant only by checking

☐ My agent may consent to my voluntary admission to a mental health treatment facility for up to [____] days, no more than 3 days (72 hours). If checked, fill in the number. Without this specific authorization, my agent may not use this power (§ 2518(e)).

☐ My agent may consent to my placement in a nursing home for more than 100 days even if a feasible alternative exists, I object, or I am not terminally ill (§ 2518(f)–(g)). Without this specific authorization, the statute restricts such placement.

5. Revocation and earlier instructions

I may revoke this appointment or an instruction by an act that clearly shows my intent, including an oral statement to a health care professional, subject to the capacity and mental health directive exceptions in § 2515(a). A later directive that conflicts with an earlier one ordinarily revokes the earlier directive only to the extent of conflict (§ 2515(c)). Unless this document provides otherwise, the appointment of a spouse or domestic partner can be revoked by the separation or relationship events listed in § 2515(d).

6. My signature and required adult witness

I intend this document to appoint my named agent and express the limits I have selected. I sign or adopt it voluntarily and knowingly.

My signature: [________________________________] Date: [__/__/____]

My printed name: [________________________________]

Witness: I am an adult. I reasonably believe the individual signed or acknowledged this document voluntarily and knowingly. I was present when the individual signed or represented that this document reflects the individual's wishes. I am not the named agent or the agent's spouse, domestic partner, or cohabitant. If the individual resides or receives care in a nursing home or long-term care facility, I am not its owner, operator, employee, or contractor. These are the witness qualifications in 16 Del. C. § 2508(d). A notary signature alone does not replace this required witness.

Witness signature: [________________________________] Date: [__/__/____]

Witness printed name: [________________________________]

Witness address or contact: [________________________________]

Delaware sources

• 16 Del. C. Chapter 25 — current Uniform Health-Care Decisions Act, especially §§ 2502, 2508, 2511, 2515, 2517–2520.