Durable Power of Attorney for Health Care - Iowa

Initials ________
Date ________
ii
While you have a choice not to complete this document, you should know that others may have to make
health care decisions for you at some point in the future. Without knowing your wishes, these decisions
can be very difficult for other people to make. Completing this document can help you talk to your circle
of support about what is important to you and can help them make decisions that match your goals and
values.
What if I decide to cancel my Durable Power of Attorney for Health Care form?
You have the right to cancel your Durable Power of Attorney Health Care form at any time. You can do
this by informing your health care agent in person or in writing. You may also inform your health care
provider. They will write down that you canceled this form in your medical record. You should also
inform any other person to whom you have given a copy. Your current and valid form will cancel out any
older versions. If your spouse is your health care agent, and you get divorced, the power granted to
your spouse by this form is revoked. If you would remarry your spouse, this power is reinstated unless
you cancel it.
Who should I choose to be my Health Care Agent?
A family member or friend who:
Is at least 18 years old
Knows you well
Can be there for you when you need them
Is willing to learn about your goals and values for health care decisions
You trust will do what is best for you, and will follow your wishes
Can make decisions under sometimes stressful situations
What kind of choices can my Health Care Agent make?
They can decide:
Which doctors, nurses, or social workers may provide care to you
Which hospitals or clinics will treat your conditions
The types of medicines, immunizations/vaccinations, tests, or treatments you could get
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