Alabama Medical Power of Attorney Form

The Alabama medical power of attorney form, also referred to as an ‘Advance Directive’, allows a person to elect another individual to handle end-of-life decisions. This document directly addresses the medical wishes only of the principal or person drafting this document. This document will, state in writing, how the principal would like to have their end of life scenario handled by whomever they may appoint as their agent(s) or attorneys-in-fact. This will also assist the principal’s physicians to better understand their wishes as to how little or how much further treatment the principal would like to have in the event they are near death or in any critical health situation.

Laws – Section 26-1-2

How to Write

Step 1 – Download the form and begin by entering the following on the 1st page:

  • The date this document is being drafted (dd/mm/yyyy format)
  • Name of Principal
  • Principal’s physical address
  • Principal’s telephone number(s)

Step 2 – Designate – In this section you will designate the person you would trust to handle your medical decisions according to your (the principal’s) wishes.

  • Provide the name of your attorney in fact
  • Provide the physical address of your attorney in fact
  • Provide the telephone number(s) where your attorney in fact may be reached

Step 3 – Successor Attorney(s) In Fact – In the event your first choice for your attorney in fact is, for whatever reason, unable or unwilling to assist in making health care decision on your behalf, you may wish to appoint or designate one or two successor attorney(s) in fact to oversee your wishes as stated. If you would like to designate others complete sections A and B as follows:

  • Enter the name of your second choice as successor attorney in fact
  • Provide the address of your second successor’s physical address
  • Provide the telephone number(s) for your second designee

In section B provide your third selected attorney in fact or your second successor attorney in fact in the event either your first or second attorney’s in fact are unwilling or unable to assist in making your medical decisions as you specify:

  • Enter the name of your third chosen attorney in fact
  • Provide the physical address of your third successor
  • Provide the telephone number(s) for your third designee

Your medical power of attorney will become effective only when you become disabled, incapacitated or are no longer able to make your own health care decisions. Any previous documents of this nature will be revoked. This document will be the current and usable document.

Step 4 – General Presumption for Life – This section will address what is to be presumed by your physicians and your attorney in fact to be what you would like to be done, especially if there is any opportunity for a full or reasonable recovery of your health care situation. Read or have someone read this information to you, so that you understand what will be presumed by your physicians and your attorney(s) in fact.

Step 5 – When My Death is Imminent – This section will address what you would like withheld in the event your life could possibly end within a week or less.

  • Complete the lines provided, being as specific as you possibly can, what you would like withheld from you ie: specific medications, fluids, feeding tubes or anything that may be given to you to prolong your life. If more room is required, you may use an additional sheet to be certain that your wishes are properly interpreted.

Step 6 – When I Am Terminally Ill – This section will allow you to address what you would like to maintain and what you would like to withhold in the event you are within three months or less of an end of life process. You may choose to continue life saving possibilities or you may choose to withdraw anything that may be life saving.

  • Enter your choices for yourself into the lines provided, be as specific as possible. If more room is needed, you may use an additional sheet to be certain that all of your wishes are properly interpreted.

Step 7 – Other Special Conditions – If there are other special conditions you would like to state you may state them here, ie: you would like your specific religious representative to come and administer prayer or last rights only for example, state these things here. Or if you would like no religious representative present at any time, state this specifically. Another example, if you would like your family and/or friends to be allowed to be with you at the end of your life, be certain to place information like this, in this area. These are only examples of special conditions. Whatever you choose to be in this area, if anything at all, be as specific as possible so that your wishes are honored by all involved.

Step 8 – If I Am Pregnant – If you are pregnant and would like to do all that can be done to preserve the life of your child, in an end of life situation, you would specify any special conditions with regard to this situation in the lines provided. If you require more room to be certain that your wishes are understood clearly, add them on a separate sheet. Read the information in this section.

  • Note the box stating that you would like all medical assistance possible if you are not terminally ill, to protect the life of both yourself and your unborn child, even if the child may lose their life as a result. If this is your wish, place your signature inside of the box under the statement.

Step 9 – Once you’ve completed the form in the manor in which you’ve chosen in all of the sections, you will be required to provide the following information:

  • Signature of Declarant (principal)
  • Your City, County and State of residence
  • The date in which you signed the form

Step 10 – This document requires that you have two witnesses to state that they believe you to be of sound mind when the form was completed and signed. Your witnesses may not be related by blood or marriage, nor may they be named in your estate. They must provide the following information:

  • The name of each witness
  • The signature of each witness
  • The date each witness signed the document

This would complete the information needed for this document to be considered your legal and enforceable power of attorney.