Health Care Proxy Template – Free & Customizable Medical Power of Attorney

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What Is a Health Care Proxy?

A health care proxy is a legal document that allows you to appoint someone to make medical decisions on your behalf if you become unable to communicate. It’s also known as a:

  • Medical Power of Attorney

  • Health Care Power of Attorney

  • Advance Directive (in some states)

This document is crucial for emergencies, hospital stays, long-term care planning, or end-of-life decisions.


Why You Need a Health Care Proxy

Accidents, illness, or surgery can leave you unable to express your medical preferences. A health care proxy ensures:

✅ Your wishes are respected ✅ Your loved one has legal authority to act ✅ Doctors know who to communicate with ✅ You avoid unwanted procedures or confusion

Without one, your care decisions may be made by the hospital or state — not your family.


What’s Included in a Health Care Proxy Template?

Wansom AI’s health care proxy template includes:

  • Your full legal name and contact details

  • Name of your appointed health care agent

  • Alternate agent (optional)

  • Agent’s authority and limitations

  • Special medical instructions (e.g. life support, organ donation)

  • Witness and/or notary section (varies by state)


Is It Legally Valid in Every State?

Yes — Wansom’s template adapts to your selected U.S. state. It follows each state’s witnessing and notarization rules to ensure validity.

Some states also combine the health care proxy with a living will — our system will guide you accordingly.


How to Create a Health Care Proxy with Wansom AI

You can generate your fully customized medical power of attorney in minutes:

  1. ✅ Go to www.wansom.ai/register

  2. Choose “Health Care Proxy / Medical Power of Attorney”

  3. Answer a few simple questions

  4. Download and print your personalized document


Why Use Wansom AI Drafting?

  • ✅ Easy, AI guided process

  • ✅ Jurisdiction specific

  • ✍️ Legally formatted and ready to sign

  • 🆓 One free fully customized template


Download Your Health Care Proxy Form Now

Don’t leave your medical future to chance. With Wansom AI, you can create a secure, state-compliant health care proxy in minutes — and give your loved ones peace of mind.

👉 Create Your Health Care Proxy with Wansom AI →