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West Virginia Medical Power of Attorney Form

Appoints a representative and successor for health care decisions during incapacity, subject to the principal’s wishes and special directives.

Jurisdiction
West Virginia
Purpose
Medical & health care
Source / form version
2022 statutory form; file uploaded in 2026. Upload year is not represented as the form edition.
Resource format
PDF
Signing
Principal signs and dates; two qualified adult witnesses sign; acknowledgment before a notary is also required.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Name a representative and successor

This West Virginia medical form appoints a person to communicate with the care team and make health care decisions when you cannot. Add a successor and current contact information. Before naming a treating professional or facility employee, check the statutory eligibility restrictions and family exceptions; professional familiarity alone does not establish eligibility.

Sources: [1] [3] [4]

Put meaningful wishes in the directive space

The appointment grants broad medical authority, but the special-directives area lets you express limits and preferences. Discuss those instructions with the representative and a clinician so they can be understood in real situations. Keep any existing living will consistent with the directions you include and make sure the people involved know which documents are current.

Sources: [1] [3] [4]

Arrange witnesses and a notary

This medical form uses both two adult witnesses and notarization. The witnesses must satisfy the printed restrictions, including exclusions for the named representative or successor, certain relatives and beneficiaries, the attending physician, and people directly responsible for medical costs. Arrange eligible participants before signing rather than treating the notary as a replacement witness. Share complete signed copies with the representative, successor, and medical providers.

Sources: [1] [3] [4]

Common questions

Is the PDF a new 2026 form?

The publisher uploaded this file in 2026, but it identifies the 2022 statutory form. The upload date is not a new legal edition.

Sources: [1] [3] [4]

Can I use just witnesses or just a notary?

No. West Virginia’s written medical POA execution process requires two qualified adult witnesses and acknowledgment before a notary. Both parts of the signing section need attention.

Sources: [1] [3] [4]

Related forms and guides

Sources and verification

  1. West Virginia State Bar: source and instructions (opens in a new tab)
  2. Direct PDF (opens in a new tab)
  3. West Virginia Code §16-30-4 (opens in a new tab)
  4. West Virginia Center for End-of-Life Care — medical POA (opens in a new tab)

HTTP 200; three pages, no AcroForm fields. The file identifies §16-30-4(h), 2022/SB470. Current statute and both witness and notary blocks checked. No false 2026 revision claim.

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.