Illinois Power Of Attorney For Health Care Form

Jurisdiction: Illinois
Purpose: Medical & health care
Source / form version: Publisher PDF marked effective July 30, 2021
Resource format: PDF
Signing: Principal signature and an eligible adult witness; no notarization required for this form

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

Select one authority option

The form separates three choices: decisions after inability to decide, that same decision rule with earlier records access and communication, or decisions beginning immediately. If you want earlier information access without transferring current decisions, read the middle option carefully.

The appointment does not prevent you from making your own decisions while you are able. Discuss the selected timing with the agent and the professionals who will rely on the document.

Sources: [2] [3]

Use an eligible adult witness

For this statutory form, the principal and witness both sign. Notarization is not required. The witness must be at least 18 and must meet the exclusions described by the form and §4-5.1.

The agent or successor cannot witness it. Restrictions also cover specified family relationships, treating professionals and their relatives, and facility owners or operators and their relatives. Have the proposed witness read the complete declaration before agreeing to sign; do not assume any adult present will qualify.

Sources: [2] [4]

Record preferences and provide a backup

Choose a person who understands your values and will discuss difficult decisions with the care team. A successor provides a backup if the first agent is unavailable or unwilling. The form provides for one agent serving at a time.

Use its preference and limitation areas to address care choices that matter to you. Discuss an existing living will or other directive with the agent so the documents can be understood together. Give copies to the agent, successors and treating professionals.

Sources: [2] [3]

Review the optional 30-day delay

The form includes an optional election delaying revocation for 30 days after you communicate an intent to revoke. This can affect how long the agent continues acting after that communication. It is a substantive choice, not a routine required checkbox.

Section 4-6 describes revocation methods and written amendments. If you intend to change or cancel the appointment, follow that provision and communicate the change to those relying on it. Obtain advice if you are uncertain about the delay election or the required revocation procedure.

Sources: [5] [6]

Common questions

Does the health care form require notarization?

The linked statutory health care form instructs the principal and an eligible witness to sign and says notarization is unnecessary. Property powers have different requirements.

Sources: [2]

Must I choose delayed revocation?

No. The 30-day delayed-revocation election is optional. Review its consequences before selecting it.

Sources: [5]

Related forms and guides

Sources and verification

PDF downloaded and text inspected. Edition is the publisher’s stated edition, not a claim of a newly drafted form. Illinois legislature access was intermittent; existing source-researched guidance retained.

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.

Illinois Power of Attorney for Health Care Form