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Nebraska Power of Attorney for Health Care Form DC 6:13

The appointed attorney in fact makes health care decisions when the principal is incapable, subject to written instructions and limits.

Jurisdiction
Nebraska
Purpose
Medical & health care
Source / form version
DC 6:13, revision March 2016
Resource format
PDF
Signing
Sign and date before two eligible adult witnesses or acknowledge before a notary who is not the agent or successor.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Name an agent and successor

The Judicial Branch’s three-page health form identifies a primary agent and backup. It asks the principal to initial acknowledgments about understanding the appointment. Complete these intentionally and talk with both people about availability, values and any limits before collecting signatures.

Sources: [2] [3] [4]

Write treatment instructions separately

The form provides distinct spaces for general limits, life-sustaining treatment and artificially administered nutrition and hydration. These topics need not have identical instructions. Its warning also explains that the principal may require a second physician to confirm future incapacity. Ask for clarification if the effect of a condition is unclear.

Sources: [2] [3] [4]

Check the witness route carefully

Nebraska permits two adult witnesses or a notarial acknowledgment. Section 30-3405 excludes specified relatives, heirs, the agent, attending professionals and other listed people from witnessing; no more than one witness may be a caring provider’s administrator or employee. The notary cannot be the agent or successor. Do not sign first and expect an unrelated later signature to complete the process. Fill in the principal’s and agents’ contact details legibly. When providing copies, include the limits and treatment instructions rather than only the page identifying the agent.

Sources: [2] [3] [4]

Common questions

Is notarization always required?

No. Nebraska’s health-power statute allows either the qualified two-witness route or acknowledgment before an eligible notary.

Sources: [2] [3] [4]

Can I add a condition requiring another physician?

The court form expressly explains that a second-physician confirmation of incapacity may be required in the document.

Sources: [2] [3] [4]

Related forms and guides

Sources and verification

  1. Nebraska Judicial Branch: source and instructions (opens in a new tab)
  2. Published form (opens in a new tab)
  3. Nebraska §30-3404, health-power contents and execution (opens in a new tab)
  4. Nebraska §§30-3401–3432, witness exclusions and health powers (opens in a new tab)

3-page court PDF downloaded and text inspected; revision printed March 2016. Current legislature text consulted for witness exclusions rather than assuming the old footer states current law.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.