Minnesota Health Care Directive Form

Read the instructions and complete the appointment

HealthPartners supplies an eight-page packet containing instructions and a four-page Minnesota directive. Complete Section A, the agent appointment in Section B and/or treatment instructions in Section E, and the signature section. Name alternates if desired. When adding joint agents, explain how disagreements will be resolved and whether independent decisions are allowed.

Sources: [2]

Distinguish ordinary and additional powers

Section C describes authority over treatment, records, providers and living arrangements. Separate initials grant additional powers, including decisions while you can still speak for yourself. Review each choice instead of initialling the entire group. Section D records values; Section E addresses CPR and future treatment choices. Discuss those preferences with your clinician.

Sources: [2] [1]

Complete the Minnesota signature verification

Under Minnesota Statutes 145C.03, sign and date a written directive identifying you and containing instructions or an appointment. Use a notary or two eligible witnesses. The agent and alternate cannot serve as witness or notary. At least one witness must be outside the direct-care provider and its employees. Keep verification with the directive.

Sources: [3]

Give copies to the people involved

Keep the signed document accessible and give copies to your agents and care team. The packet advises reviewing it after health or life changes, so an outdated copy does not guide a new situation.

Sources: [2] [1]

Related forms and guides

• Minnesota Power of Attorney Forms
• Minnesota Statutory Short Form Power of Attorney
• Medical Power of Attorney and Health Care Proxy Forms
• Medical vs. Financial Power of Attorney

Sources and verification

1. HealthPartners: source and instructions ↗ (opens in a new tab)
2. Minnesota directive with instructions, 8-page PDF ↗ (opens in a new tab)
3. Minnesota Statutes §145C.03, legal sufficiency and exclusions ↗ (opens in a new tab)

Source page links the exact 8-page PDF with instructions. Direct download HTTP 200 (118,792 bytes); full text inspected, AcroForm fields present. Printed 8/2021 edition retained honestly. Current §145C.03 checked. Replaces Attorney General endpoint returning 503; Honoring Choices domain rejected because its homepage currently returned unrelated gambling content.

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.