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Missouri Durable Power of Attorney for Health Care and Health Care Directive

The health-agent appointment starts on incapacity certified by the one-physician or two-physician option selected in the form.

Jurisdiction
Missouri
Purpose
Medical & health care
Source / form version
Form revised 2023; publisher file path updated August 2024
Resource format
PDF
Signing
Complete the principal signature and notarial acknowledgment in Part 3, following the Bar’s instructions.
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Sources checked: 2026-11-13. General information, not individual legal advice.

Use either or both substantive parts

The Missouri Bar’s four-page form combines an agent appointment with a health care directive. Part 1 names the agent and alternates; Part 2 states treatment wishes. The instructions explain how to omit a part you do not want. Part 3 supplies execution, and the separate Bar booklet gives fuller explanations.

Sources: [2] [3] [4]

Choose the capacity and feeding options

Part 1 asks whether one physician or two must certify the inability to make and communicate health care decisions. It also asks for a specific initialled choice about artificial nutrition and hydration. Resolve each choice deliberately. These are different decisions from merely listing an emergency contact or naming an alternate.

Sources: [2] [3] [4]

Print, initial and acknowledge

The Bar offers interactive fields, but its guidance says some required initials must be added after printing. Review the complete printout, then sign with the notarial acknowledgment. Give copies to the agent and providers. The separate HIPAA authorization linked by the Bar serves an information-access purpose and does not replace the agent appointment. Check the order of alternate agents and their current contact details. The first person unavailable in an emergency should not leave providers guessing whom to contact next.

Sources: [2] [3] [4]

Common questions

Do all required initials fill on screen?

No. The Bar specifically tells users to initial marked areas after printing because those initial fields are not fillable.

Sources: [2] [3] [4]

Is this a financial power of attorney?

No. Its focus is health care decisions and treatment instructions; use a separate financial document for property matters.

Sources: [2] [3] [4]

Related forms and guides

Sources and verification

  1. The Missouri Bar: source and instructions (opens in a new tab)
  2. Published form (opens in a new tab)
  3. Missouri Bar complete booklet and instructions (opens in a new tab)
  4. Missouri Legal Services referral to Bar forms (opens in a new tab)

4-page PDF downloaded and inspected with AcroForm fields. Footer says Revised 2023; upload-path year is not described as a new legal revision.

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.