Nebraska Health Care (Medical) Power of Attorney Form

The Nebraska Health Care (Medical) Power of Attorney (Form MLTC-PB-3) is a form that is supplied by the Nebraska State Unit on Aging to make the process of creating a Power of Attorney for future health circumstances as painless as possible. Using the form, an individual (referred to as the Principal) is able to appoint an Attorney in Fact for Health Care. The Principal has full autonomy to decide whether they want to authorize their Attorney in Fact to: make health care decisions for them when they are medically incapable of doing so themselves; follow certain instructions or limitations they have noted in the form; and/or comply with certain instructions regarding life-sustaining treatment and/or artificially administered nutrition and hydration.

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State Laws & Signing Requirements

State Laws – Power of Attorney For Health Care (Sections 30-3401 to 30-3432)

Signing Requirements (§ 30-3404) – The Power of Attorney for Health Care must be signed by the Principal and either:

  • Witnessed and signed by at least two (2) adults, or
  • Acknowledged before a Notary Public.

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