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PowerofAttorney.com
Limited Power of Attorney to Make Emergency Health Care Decisions for My Minor Child
Effective Only if No parent or Legal Guardian is Readily Available
1. POWER OF ATTORNEY
I, {name of parent or legal guardian} (hereinafter called
parent), domiciled and residing in {Country}, designate
{name(s) of Attorney-in-Fact} as my Attorney(s)-in-Fact to make health
care decisions for my child {name of Child} (hereinafter called Child) over
whom I have legal custody and guardianship. This limited power of attorney is effective if my
Child’s parent or legal guardian is not readily available and authorized to give consent or until
my Child reaches the age of 18.
The appointment of the Attorney-in-Fact is made pursuant to RCW 11.94.010(4).
In case my Child requires health care treatment, the Attorney-in-Fact shall have the power to do
the following:
(a) Arrange for suitable, transport, hospital or in-patient treatment;
(b) Make emergency determinations regarding the appropriate health care for my Child,
including but not limited to dealing with attending physicians and determining, in the
judgment of the Attorney-in-Fact, which course of treatment is necessary or desirable,
and approving follow-up care. Common examples of emergencies as defined in this
document include injuries resulting from a serious car accident, unconsciousness, or other
situation causing serious physical or mental trauma. Non-emergencies include visits to
the doctor for elective medical procedures, routine doctor’s visits, and any other situation
or condition where urgency is not evident to the Attorney-In-Fact. In all cases, the
Attorney-In-Fact will be the sole determiner as to whether or not a particular situation or
condition rises to the level of an emergency;
(c) Review and/or order the medical records of my Child.
2. POWERS NOT SPECIFICALLY ENUMERATED
The Attorney-in-Fact shall also have all powers which may be necessary or desirable to provide
for the personal and health care decision making of my Child even if these powers are not
specifically set forth in this document.
3. DURATION
This Durable Power of Attorney shall become effective upon signing, and shall remain in effect
to the extent permitted by Washington State law and until revoked or terminated, or until my
Child reaches the age of 18.
