Vermont Medical (Health Care) Power of Attorney Form


State laws (18 V.S.A. § 9701) regarding Vermont Medical (Health Care) Power of Attorney forms define these legal agreements as written records created by a capable individual “which may include appointment of an agent, identification of a preferred primary care clinician, instructions on health care desires or treatment goals, an anatomical gift, disposition of remains, and funeral goods and services. ” A capable individual is defined by this same state law as someone who possesses:

  1. A basic understanding of the implications of having another individual (their Agent) make health care decisions on their behalf,
  2. The ability to appoint an appropriate individual to make such decisions, and
  3. The ability to identify whom they want to make health care decisions for themselves.

State Laws & Signing Requirements

State Laws – Advance Directives For Health Care, Disposition Of Remains, And Surrogate Decision Making

Signing Requirements (18 V.S.A. § 9703) – State law mandates that in order for an Medical (Health Care) Power of Attorney / Advance Directive to be lawfully executed it must be:

  1. Dated, executed, and signed by the Principal (or, if the Principal cannot physically do so themselves they may direct another individual to sign for them in their presence),
  2. Completed in the presence of two (2) or more witnesses who must sign and affirm the Principal met the requirements set out in 18 V.S.A. § 9703.

In addition to signing requirements, additional requirements exist if the Principal is being admitted to or is a resident of a nursing home or residential facility at the time the Advance Directive is executed. In such cases, it is mandatory that one of the individuals listed in 18 V.S.A. § 9703(d) “explains the nature and effect of an advance directive to the principal and signs a statement affirming that he or she has provided the explanation.” The individual may be one of the following parties:

  • An ombudsman
  • A recognized member of the clergy,
  • an attorney licensed to practice in this State,
  • A Probate Division of the Superior Court designee,
  • An individual designated by a hospital pursuant to subsection 9709(d) of this title,
  • A mental health patient representative,
  • An individual who is volunteering at the nursing home or residential care facility without compensation and has received appropriate training regarding the explanation of advance directives, or
  • A clinician, as long as the clinician is not employed by the nursing home or residential care facility at the time of the explanation.