The Connecticut Health Care Power of Attorney is to be used when you want to appoint someone to make any health care related decisions on your behalf, the attorney-in-fact may only make such decisions when your attending physician or a certified medical professional certifies that you are unable or not capable of making these decisions on your own. This form can only be used in the State of Connecticut.
How to Fill the Connecticut Health Care Power of Attorney Form
The form begins with the notice explaining the law for the same after which the full and legal name (first, middle, last) of the principal followed by the full and legal name of the attorney-in-fact (first, middle, last) needs to be stated. After that, there are five points explaining how and where the powers can be used and that the decisions taken by the attorney-in-fact (with or without the consent of family, friends or physician) shall be considered as equal to theirs facsimile. This agreement shall take effect after a certified medical professional term the principal as medically or physically unfit to take decisions for themselves and by executing this agreement any or all such powers allotted in the past shall be terminated.
Lastly, the document needs to be dated and signed by the principal certifying the transfer of power to the attorney related to healthcare matters who is considered trustworthy and reliable and that the decisions taken by them shall be in the best interest of the principal followed by the full name, complete addresses and signatures of two witnesses. This document also needs to be notarized by the Notary Public along with mentioning the county and the town for it to be considered legal.
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Connecticut Health Care Power of Attorney Form
Preview Connecticut Health Care Power of Attorney Form 
Connecticut Health Care Power of Attorney Form