Iowa Durable Power of Attorney for Health Care

(Comprehensive Drafting Template — Court-Ready)

[// GUIDANCE: This template is intentionally robust. Practitioners may streamline or delete provisions that exceed the Principal’s needs so long as statutory compliance is preserved. Citations are provided only where foundational and certain in accordance with the governing Citation Policy.]

TABLE OF CONTENTS

I. Document Header
II. Definitions
III. Operative Provisions
 A. Appointment & Acceptance of Agent
 B. Scope of Authority
 C. End-of-Life Provisions
 D. HIPAA Authorization
 E. Limitations on Agent Powers
 F. Term & Effectiveness
IV. Representations & Warranties
V. Covenants & Restrictions
VI. Default & Remedies
VII. Risk Allocation
VIII. Dispute Resolution
IX. General Provisions
X. Execution Block (Signature, Witness, Notary)

I. DOCUMENT HEADER

1. Title. Durable Power of Attorney for Health Care (the “Agreement”).
2. Parties.
   a. Principal: [PRINCIPAL FULL LEGAL NAME], residing at [PRINCIPAL ADDRESS].
   b. Agent: [PRIMARY AGENT FULL LEGAL NAME], residing at [AGENT ADDRESS].
   c. Alternate Agent(s) (optional):
     i. First Alternate: [ALT1 NAME], residing at [ALT1 ADDRESS].
     ii. Second Alternate: [ALT2 NAME], residing at [ALT2 ADDRESS].
3. Effective Date. This Agreement is executed on [EFFECTIVE DATE] and is intended to be immediately effective in accordance with Iowa Code § 144B.3(2) unless otherwise specified herein.
4. Governing Law. This Agreement is governed by the laws of the State of Iowa, including Iowa Code ch. 144B (the “Act”) and applicable federal privacy regulations, 45 C.F.R. § 164.508.
5. Consideration. Mutual promises and the Principal’s desire to ensure continuity of health-care decision-making constitute sufficient consideration.

II. DEFINITIONS

For purposes of this Agreement, capitalized terms have the meanings below:

“Act” means Iowa Code ch. 144B, as amended.
“Agent” means the individual designated in Section III.A with authority granted herein.
“Alternate Agent” means any successor Agent designated in Section III.A.3.
“Good Faith” means honesty in fact and observance of reasonable standards of health-care decision-making consistent with the Principal’s known wishes.
“Health-Care Decision” has the meaning set forth in Iowa Code § 144B.1(2).
“HIPAA” means the Health Insurance Portability and Accountability Act of 1996 and its implementing regulations.
“Incapacity” means the inability, as determined under Section III.F.1, to understand and appreciate the consequences of a treatment decision.
“Life-Sustaining Procedure” has the meaning provided in Iowa Code § 144A.2(6).
“Principal” means the person executing this Agreement.
“Protected Health Information” or “PHI” has the meaning assigned in 45 C.F.R. § 160.103.

[// GUIDANCE: Add or delete defined terms as needed, ensuring cross-references are updated.]

III. OPERATIVE PROVISIONS

A. Appointment & Acceptance of Agent

1. Designation. The Principal hereby appoints the Agent to make any and all Health-Care Decisions on the Principal’s behalf whenever the Principal lacks Capacity.
2. Durable Authority. This power of attorney is durable and shall not be affected by the Principal’s subsequent Incapacity or disability.
3. Alternate Agents. If the Agent is unable, unwilling, or unavailable to serve, authority shall pass in the order listed in Section I.2.c.
4. Acceptance. By signing in the Execution Block, each Agent accepts the appointment and the duties set forth herein.

B. Scope of Authority

1. General Powers. Subject to Section III.E, the Agent may:
   a. Consent to, refuse, or withdraw any medical or surgical procedure, including Life-Sustaining Procedures;
   b. Authorize admission to or discharge from any health-care facility;
   c. Review, obtain, and disclose PHI;
   d. Hire and fire health-care providers;
   e. Execute waivers or releases of liability required by providers.
2. Financial Incidents. The Agent may incur reasonable medical expenses chargeable to the Principal and execute related documents but holds no general financial power beyond health-care contexts.
3. Anatomical Gifts & Autopsy. The Agent may consent to autopsy, organ donation, or disposition of remains unless expressly limited in Section III.E.

[// GUIDANCE: Iowa permits broad delegation; tailor subsections to client instructions.]

C. End-of-Life Provisions

1. Statement of Intent. These directives supplement, and do not revoke, any separate Iowa “Declaration Relating to Life-Sustaining Procedures” unless explicitly revoked in Section IX.2.
2. Principal’s Preferences.
   a. Artificial Nutrition & Hydration: [CHECK ONE] ☐ Provide ☐ Withhold/Withdraw ☐ Agent to Decide
   b. Pain Relief: The Agent may authorize palliative care even if it may hasten death.
   c. Cardiopulmonary Resuscitation (CPR): [CHECK ONE] ☐ Full Code ☐ DNR ☐ Agent to Decide
3. Escalation Standard. If the Principal’s wishes are unknown, the Agent shall act in Good Faith and in the Principal’s best interest, considering prognoses and burdens of treatment.

D. HIPAA Authorization

1. Full Release. The Principal authorizes any covered entity to disclose PHI to the Agent to the same extent as the Principal under 45 C.F.R. § 164.508.
2. Redisclosure. The Agent may redisclose PHI as reasonably necessary to fulfill duties; such redisclosure may no longer be protected by HIPAA.
3. Expiration. This authorization is effective immediately and, unless revoked, expires upon the Principal’s death plus six (6) years.

E. Limitations on Agent Powers

1. Mental Health Commitment. This Agreement does not authorize involuntary civil commitment.
2. Sterilization or ECT. The Agent may not consent to non-therapeutic sterilization or electro-convulsive therapy unless expressly initialed here: ____.
3. Revocation by Principal. The Principal may revoke this Agreement pursuant to Section IX.2.
4. Conflicts of Interest. The Agent shall not make gifts or transfers that financially benefit the Agent, except reimbursement of out-of-pocket medical expenses incurred on the Principal’s behalf.

F. Term & Effectiveness

1. Determination of Incapacity. Incapacity shall be established by: (i) written certification of one licensed physician or, (ii) if expressly elected □ here _____, by the Agent based on personal observation.
2. Duration. Authority continues until the earliest of (i) Principal’s death, (ii) valid revocation, or (iii) judicial termination.
3. Post-Death Authority. Limited authority to arrange for autopsy, anatomical gifts, and funeral/burial decisions survives the Principal’s death unless restricted above.

IV. REPRESENTATIONS & WARRANTIES

1. Principal warrants full legal capacity to execute this Agreement.
2. Each Agent represents (i) age 18 or older, (ii) not currently serving as the Principal’s attending physician or employee thereof (unless permitted by Iowa Code § 144B.3(1)(b)), and (iii) willingness to act in Good Faith.
3. Survival. These representations survive acceptance and termination of the Agent’s authority.

V. COVENANTS & RESTRICTIONS

1. Standard of Care. The Agent shall act (i) in Good Faith, (ii) consistently with the Principal’s known wishes, and (iii) otherwise in the Principal’s best interest.
2. Record-Keeping. Upon request of an interested person, the Agent shall provide a written report of actions taken under this Agreement within fifteen (15) days.
3. Notice Obligations. The Agent shall promptly notify Alternate Agents of inability to continue serving and, if applicable, inform health-care providers of revocation.

VI. DEFAULT & REMEDIES

1. Events of Default. The following constitute default: (i) breach of fiduciary duty, (ii) self-dealing, (iii) failure to act, or (iv) incapacity of the Agent.
2. Notice & Cure. Any interested person may provide written notice; the Agent has ten (10) days to cure or rebut before judicial intervention.
3. Remedies. The Iowa probate court may remove the Agent, appoint a guardian, or grant injunctive relief to enforce the Principal’s healthcare directives.
4. Attorneys’ Fees. A prevailing party in litigation arising under this Agreement is entitled to reasonable costs and attorneys’ fees.

VII. RISK ALLOCATION

1. Indemnification. To the fullest extent permitted by law, the Principal indemnifies the Agent from liability, expense, or loss arising out of authorized acts taken in Good Faith.
2. Limitation of Liability. The Agent shall not be liable for actions taken in Good Faith and in accordance with this Agreement or the Act.
3. Insurance. [OPTIONAL] The Principal shall maintain health-care decision fiduciary insurance with limits of [INSERT AMOUNT].
4. Force Majeure. The Agent is excused for failure to act when impossible due to events beyond reasonable control (e.g., natural disasters, widespread electronic failures).

VIII. DISPUTE RESOLUTION

1. Governing Law. Iowa law, without regard to conflict-of-laws principles, governs this Agreement.
2. Exclusive Forum. Any proceeding shall be commenced in the [COUNTY] County Probate Court of Iowa, which shall have exclusive jurisdiction.
3. Arbitration. Arbitration is expressly not available.
4. Jury Waiver. No jury waiver is provided; statutory rights remain intact.
5. Injunctive Relief. Interested persons may seek temporary, preliminary, or permanent injunctive relief to enforce the Principal’s healthcare directive.

IX. GENERAL PROVISIONS

1. Amendment. The Principal may amend this Agreement only by executing a written instrument with the same formalities as this Agreement.
2. Revocation. This Agreement may be revoked by (i) a signed, dated writing, (ii) destruction of the original by the Principal, or (iii) oral statement in the presence of two witnesses.
3. Assignment. No Agent may delegate authority except to licensed healthcare professionals acting under the Agent’s supervision.
4. Severability. Invalid provisions shall be severed and the remainder enforced.
5. Integration. This document constitutes the entire durable power of attorney for health care of the Principal, superseding all prior inconsistent instruments.
6. Copies. Photographic or electronically transmitted copies shall be as effective as originals.
7. Counterparts & Electronic Signatures. This Agreement may be executed in counterparts and via electronic signature under Iowa Code § 554D.103 et seq.

X. EXECUTION BLOCK

PRINCIPAL

I, [PRINCIPAL NAME], sign my name to this Durable Power of Attorney for Health Care on [DATE] at [CITY], Iowa.

[PRINCIPAL NAME], Principal

AGENT ACKNOWLEDGMENT

I, [AGENT NAME], accept the appointment and will act in accordance with the foregoing instrument and Iowa law.

[AGENT NAME], Agent  Date: ____

[Duplicate blocks for each Alternate Agent]

WITNESS ATTESTATION (Choose EITHER Witnesses or Notary)

We declare that the Principal appears to be of sound mind and under no undue influence, and that the Principal signed or acknowledged signing this instrument in our presence.

1. ______ Date: _
   [WITNESS 1 NAME], Address: ______

2. ______ Date: _
   [WITNESS 2 NAME], Address: ______

OR

NOTARIAL ACKNOWLEDGMENT

State of Iowa  )
County of [____] ) ss.

On this ___ day of ____, 20__, before me, the undersigned Notary Public, personally appeared [PRINCIPAL NAME], known to me (or satisfactorily proven) to be the person whose name is subscribed to this instrument, and acknowledged that he/she executed the same for the purposes therein contained.

Notary Public in and for the State of Iowa
Commission No.: ___
My Commission Expires: _______

[// GUIDANCE: Deliver originals to the Agent, primary physician, and place a copy in the Principal’s medical file. Encourage clients to review and update directives periodically or upon major life changes.]