Nebraska Health Care (Medical) Power of Attorney Form

The Nebraska Health Care (Medical) Power of Attorney (Form MLTC-PB-3) is a form that is supplied by the Nebraska State Unit on Aging to make the process of creating a Power of Attorney for future health circumstances as painless as possible. Using the form, an individual (referred to as the Principal) is able to appoint an Attorney in Fact for Health Care. The Principal has full autonomy to decide whether they want to authorize their Attorney in Fact to perform a variety of responsibilities, of which are listed in the section below.


Additional Requirements

As touched on above, a Health Care (Medical) Power of Attorney makes it possible for a Principal to authorize their Agent to perform actions regarding their health care when they are incapacitated. These actions may include, but are not limited to the Agent:

  • Making health care decisions for them when they are medically incapable of doing so themselves,
  • Following certain instructions or limitations they have noted in the form, and/or
  • Complying with certain instructions regarding life-sustaining treatment and/or artificially administered nutrition and hydration.

State Laws & Signing Requirements

State Laws – Power of Attorney For Health Care (Sections 30-3401 to 30-3432)

Signing Requirements (§ 30-3404) – Any Power of Attorney for Health Care enacted in Nebraska must be signed by the Principal and either:

  • Witnessed and signed by at least two (2) adults, or
  • Acknowledged before a Notary Public.