Medical Power Of Attorney printable pdf download

Medical Power Of Attorney

Medical Power of Attorney

Maryland Law prohibits medical facilities from providing any type of medical care beyond life-saving treatment to

ill or injured children without parental consent. This Medical Power of Attorney enables relatives or friends to

consent to your child’s emergency medical care when you are away or when you are not able to attend a visit with

your child.

From: ___________________________________________________________________

(full name(s) of Parent(s) or Guardian(s))

To: ______________________________________________________________________

(Name(s) of Adult(s) responsible for child)

We (I) ______________________________________________ (

full name parent/guardian)

Of ________________________________________________________

(residential address in full)

Do hereby appoint _____________________________________

(name of adult(s) responsible for

child)

Our true and lawful attorney in fact, with full power to loco parentis, to decide upon and

consent to the rendering of any medical diagnosis and treatment, including surgery, which

he/she deems in the best interest of the health and welfare of our child.

____________________________________________________________

( name of child(ren))

This Power of Attorney shall be effective during such period of time as we, or either of us, may

for any reason not be available to give our consent to any medical diagnosis or treatment,

including surgery for our child.

This Power of Attorney shall not be affected by the disability of either or both of us, but shall

continue in full force and effect during any such disability.

Executed this _____ day of _________, 20_______.

Witness:

Parent(s) signatures

_____________________________

_______________________________________

_____________________________

_______________________________________

Medical Power Of Attorney