Michigan Medical Power Of Attorney

Information you will need

• Principal Name
• Advocate Name
• Advocate Relation
• Advocate Address
• Successor Advocate Name
• Successor Advocate Relation
• Successor Advocate Address
• Outpatient Therapy
• Voluntary Mental Health Services
• Involuntary Mental Health Services
• Psychotropic Medication
• Electroconvulsive Therapy
• Right to Revoke
• Organ Donation
• LIst of Organs or Parts
• Anatomical Study
• Other Donation
• Recipient of Donation
• Specific Wishes
• Principal Signing Date
• Principal Address and Phone
• First Witness Name
• First Witness Address
• Second Witness Name

…and 4 more fields in the PDF.

Completed by the employee.

The form includes 2 signature lines, a witness section.