Rhode Island Durable Power Of Attorney For Health Care

Jurisdiction: Rhode Island
Purpose: Medical & health care
Source / form version: Printed 3/2018; five-page statutory form
Resource format: PDF
Signing: Sign before two qualified adult witnesses or one notary. At least one witness, or the notary, must also sign the form’s separate unrelated/no-estate-interest declaration.

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Sources checked: 2026-11-13. General information, not individual legal advice.

Read the statutory warning

Rhode Island’s five-page form states that the signer must be at least eighteen and a resident of the state. It appoints one health care agent, with room for two alternates, and revokes earlier health care powers. The warning explains both the breadth of the appointment and the principal’s continuing rights to make decisions and object to treatment.

Sources: [1] [4] [2] [3]

Write limits and preserve attachments

The form has space for life-prolonging treatment wishes, other health care limits and organ-donation wishes. Without specific limits, the agent receives broad authority within the law. The appointment generally continues until revoked unless you supply an earlier expiration date. If you attach extra pages, the printed instructions require you to sign and date each one at the same time as the main form.

Sources: [1] [4] [2] [3]

Complete the independence declaration

Choose the two-witness route or the notary route. Agent, alternate and specified care-provider or facility relationships are excluded from witnessing. An additional declaration at the end must be signed by at least one witness or by the notary, confirming no prohibited family or estate interest. Do not overlook that separate signature. Give complete executed copies to the agent, alternates and doctor, and keep a copy readily available for an emergency.

Sources: [1] [2] [3]

Common questions

Is notarization enough without the final declaration?

The notary option still requires the notary to sign the additional declaration about family relationship and estate interest printed at the end of the form.

Sources: [2] [1]

Related forms and guides

Sources and verification

Southcoast Health copy downloaded HTTP200:145080bytes,fivepages,noAcroFormfields. Full text inspected and final signature page visually checked. Same3/2018statutory form, publisher highlights required blanks without preselecting decisions. StateDOH original remains linked on its information page but returns automated403; healthsystem copy selected for reliable access.

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.

Rhode Island Durable Power of Attorney for Health Care