Affidavit of Medical Doctor as to Incapacity of Person In Order for Power of Attorney to Become Effective

Category:
State:
Multi-State
Control #:
US-01350BG
Format:
Word; 
Rich Text
Instant download

Description of Affidavit of Medical Doctor for Power of Attorney

This affidavit is a legal document used to confirm that an individual is unable to manage their own affairs due to incapacity. It is typically prepared by a licensed physician who evaluates the person's physical and mental health. The primary purpose of this affidavit is to establish the necessity for a power of attorney to be activated, allowing a designated person to make decisions on behalf of the incapacitated individual.

When this form is most appropriate

This affidavit is commonly used in situations where an individual is unable to make informed decisions due to health issues. Typical scenarios include:

  • The individual is suffering from a serious illness or injury.
  • The person is experiencing advanced age-related decline.
  • The individual has a mental health condition that impairs their judgment.
  • A family member or caregiver needs to activate a power of attorney for financial or medical decisions.

Who can use Affidavit of Medical Doctor for Power of Attorney

This affidavit is intended for use by:

  • Licensed physicians who are evaluating a patient's capacity.
  • Family members or caregivers seeking to activate a power of attorney.
  • Individuals who are responsible for managing the affairs of someone incapacitated.

Sections you'll need to complete

The affidavit includes several important sections, such as:

  • Physician's Information: Details about the physician conducting the evaluation.
  • Date of Examination: When the assessment of the individual's capacity took place.
  • Evaluation Results: The physician's opinion regarding the individual's ability to manage their affairs.
  • Signature and Notarization: The physician's signature and a notary public's confirmation of the affidavit's authenticity.

Tips for completing the Affidavit of Medical Doctor for Power of Attorney

Follow these steps to complete the affidavit:

  1. Identify the Physician: Fill in the name and licensing state of the physician preparing the affidavit.
  2. Document the Examination Date: Enter the date when the physical and mental examination was conducted.
  3. State the Subject's Name: Provide the name of the individual being evaluated for incapacity.
  4. Describe the Findings: Include the physician's assessment of the individual's ability to manage their affairs.
  5. Sign and Notarize: The physician should sign the affidavit and have it notarized to validate the document.

Jurisdiction-based requirements

The affidavit must comply with the laws of the state where it is executed. Specific requirements may include:

  • State licensing for the physician.
  • Notary public requirements for witnessing the signature.
  • Any additional state-mandated language or formatting for legal documents.

Advantages of the online version

Accessing this affidavit online offers several advantages, including:

  • Convenience: Download and complete the form at your own pace.
  • Editability: Easily make changes to the document as needed.
  • Legal Reliability: Ensure that the form is drafted by licensed attorneys, meeting legal standards.
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