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Free Connecticut Medical Power of Attorney Forms

Create a Connecticut-compliant healthcare power of attorney to appoint a trusted healthcare representative. Includes HIPAA authorization, end-of-life preferences, and all provisions required under Conn. Gen. Stat. § 19a-575a.

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Connecticut Healthcare Power of Attorney
PDFWord
Connecticut-compliant
Page 1 of 5
SG

Written by

Stefan Gol
AH

Fact-checked by

Anderson Hill
JD

Legally reviewed by

John Doe

Last updated February 18, 2026

Connecticut Healthcare Power of Attorney Overview

In Connecticut, a healthcare power of attorney is governed by Conn. Gen. Stat. § 19a-575a. This legal document allows you to designate a healthcare representative who can make medical decisions on your behalf if you become unable to make or communicate those decisions yourself. Connecticut law ensures that your healthcare representative has the authority to work with healthcare providers to carry out your wishes regarding medical treatment.

Your healthcare representative can make decisions about medical treatments, surgeries, medications, hospital stays, end-of-life care, and access to your medical records. The healthcare power of attorney typically takes effect only when a physician determines that you are unable to make decisions for yourself, though Connecticut law may allow you to make it effective immediately if you prefer.

Creating a healthcare power of attorney in Connecticut requires 2 witnesses and notarization is strongly recommended. While Connecticut does not mandate a specific form, the document must meet all requirements under Conn. Gen. Stat. § 19a-575a.

No

Statutory form required

2

Witnesses required

Recommended

Notarization

Recommended

HIPAA included

Connecticut Requirements

To create a valid healthcare power of attorney in Connecticut, you must meet the following requirements under Conn. Gen. Stat. § 19a-575a:

Important: Connecticut Execution Requirements

Connecticut requires 2 witnesses for a valid healthcare power of attorney. Notarization is strongly recommended for added legal protection. Witnesses cannot include your designated healthcare representative or your treating healthcare provider.

  • Legal Age: You must be at least 18 years old and mentally competent at the time of signing
  • Witnesses: Connecticut requires 2 witnesses who are not the healthcare representative or healthcare provider
  • Notarization: Recommended in Connecticut
  • Agent Designation: Name a primary healthcare representative and optionally an alternate
  • HIPAA Authorization: Recommended to include separately

How to Create Your Connecticut Healthcare Power of Attorney

Follow these steps to create a valid healthcare power of attorney that complies with Connecticut law.

1

Choose Your Healthcare Representative

Select a trusted individual to serve as your healthcare representative in Connecticut. This person should understand your healthcare values, be willing to advocate on your behalf, and be available in case of emergency. Consider naming an alternate healthcare representative as well.

2

Specify Your Healthcare Wishes

Document your preferences regarding medical treatments, end-of-life care, organ donation, DNR orders, and mental health treatment. Be as specific as possible about what treatments you do and do not want under various circumstances.

3

Include HIPAA Authorization

Add HIPAA authorization to ensure your healthcare representative can access your medical records and communicate with your healthcare providers in Connecticut. Without this, providers may legally refuse to share your medical information.

4

Sign with Witnesses

Execute the document with 2 witnesses as required by Connecticut law. Notarization is strongly recommended for added legal protection. Distribute copies to your healthcare representative, physicians, hospital, and family members.

Choosing Your Connecticut Healthcare Representative

In Connecticut, your healthcare representative will have significant authority over your medical care. Choose someone who understands your values and can make difficult decisions under pressure.

  • Trustworthy: Someone who will follow your wishes, not impose their own preferences
  • Accessible: Someone who can be reached quickly and can travel to Connecticut if needed
  • Assertive: Someone who can communicate effectively with medical professionals
  • Emotionally capable: Someone who can handle the stress of making life-or-death decisions

Sample Connecticut Healthcare Power of Attorney

Below is a preview of our Connecticut-specific healthcare power of attorney template.

STATE OF CONNECTICUT

HEALTHCARE POWER OF ATTORNEY

Conn. Gen. Stat. § 19a-575a

PRINCIPAL (You):

Name: [Your Name]
Address: [Connecticut Address]

HEALTHCARE REPRESENTATIVE:

Name: [Agent Name]
Relationship: [Relationship]
Phone: [Phone]

Connecticut Healthcare Power of Attorney FAQ

Answers to common questions about Connecticut healthcare power of attorney requirements and procedures.

Official Connecticut Resources

Use these official resources to verify Connecticut requirements and access government forms.

Create Your Connecticut Healthcare Power of Attorney

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