Nebraska Medical Power Of Attorney

Information you will need

• Agent Name
• Agent Address
• Agent Phone
• Successor Agent Name
• Successor Agent Address
• Successor Agent Phone
• Authority of Agent
• Instructions for Agent
• Instructions or Limitations
• Life Sustaining Treatment
• Life Sustaining Treatment Instructions
• Nutrition and Hydration
• Nutrition and Hydration Instructions
• Understanding of Document
• First Witness Signing Date
• First Witness Name
• Second Witness Signing Date
• Second Witness Name
• Notary Only: County
• Notary Only: Date
• Notary Only: Principal Name
• Notary Only: Commission Expiration
• Principal Name
• Principal Signing Date

Completed by the principal.

The form includes 1 signature line, a witness section.

The document text refers to the laws of Nebraska.