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Free Vermont Medical Power of Attorney Forms

Create a Vermont-compliant advance directive to appoint a trusted healthcare agent. Includes HIPAA authorization, end-of-life preferences, and all provisions required under Vt. Stat. tit. 18, § 9703.

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Vermont Advance Directive
PDFWord
Vermont-compliant
Page 1 of 5
SG

Written by

Stefan Gol
AH

Fact-checked by

Anderson Hill
JD

Legally reviewed by

John Doe

Last updated March 11, 2026

Vermont Advance Directive Overview

In Vermont, a advance directive is governed by Vt. Stat. tit. 18, § 9703. This legal document allows you to designate a healthcare agent who can make medical decisions on your behalf if you become unable to make or communicate those decisions yourself. Vermont law ensures that your healthcare agent has the authority to work with healthcare providers to carry out your wishes regarding medical treatment.

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

Creating a advance directive in Vermont requires 2 witnesses and notarization is strongly recommended. Vermont provides a statutory form that is widely accepted by healthcare facilities throughout the state.

Yes

Statutory form required

2

Witnesses required

Recommended

Notarization

Recommended

HIPAA included

Vermont Requirements

To create a valid advance directive in Vermont, you must meet the following requirements under Vt. Stat. tit. 18, § 9703:

Important: Vermont Execution Requirements

Vermont requires 2 witnesses for a valid advance directive. Notarization is strongly recommended for added legal protection. Witnesses cannot include your designated healthcare agent or your treating healthcare provider.

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

How to Create Your Vermont Advance Directive

Follow these steps to create a valid advance directive that complies with Vermont law.

1

Choose Your Healthcare Agent

Select a trusted individual to serve as your healthcare agent in Vermont. 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 agent 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 agent can access your medical records and communicate with your healthcare providers in Vermont. Without this, providers may legally refuse to share your medical information.

4

Sign with Witnesses

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

Choosing Your Vermont Healthcare Agent

In Vermont, your healthcare agent 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 Vermont 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 Vermont Advance Directive

Below is a preview of our Vermont-specific advance directive template.

STATE OF VERMONT

ADVANCE DIRECTIVE

Vt. Stat. tit. 18, § 9703

PRINCIPAL (You):

Name: [Your Name]
Address: [Vermont Address]

HEALTHCARE AGENT:

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

Vermont Advance Directive FAQ

Answers to common questions about Vermont advance directive requirements and procedures.

Official Vermont Resources

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

Create Your Vermont Advance Directive

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