Iowa Healthcare Power of Attorney Requirements

Introduction

Key Things to Know

1. 1

   Under Iowa Code Chapter 144B, the statutory form is optional, not required, so this document, which lets you (the principal) name a trusted adult (your attorney in fact, or agent) to make health care decisions for you if you become unable to make them yourself, can use that form, a different one, or none at all, as long as it meets Iowa's execution requirements.

2. 2

   Your agent's authority does not start the moment you sign. It begins only when your attending physician or attending physician assistant judges that you are unable to make your own health care decisions (Iowa Code Section 144B.1(3), 144B.6(1)).

3. 3

   Unless you limit it in the document, your agent can make any and all health care decisions for you, including consenting to, refusing, or withdrawing treatment, and reviewing your medical records.

4. 4

   Your attorney in fact cannot be a health care provider attending you on the date you sign, or an employee of that provider, unless that employee is your relative by blood, marriage, or adoption within the third degree of consanguinity (Section 144B.4).

5. 5

   You can sign in front of two witnesses, or sign before a notarial officer instead. Iowa treats both methods as fully valid; you do not need both witnesses and a notary.

6. 6

   Neither witness may be your named agent, under 18, a health care provider attending you, or that provider's employee, and at least one of the two must not be your relative within the third degree of consanguinity (Section 144B.3).

7. 7

   You can revoke the document at any time, no matter your mental or physical condition, just by telling your agent or a health care provider currently caring for you, orally or in writing.

8. 8

   If you name your spouse as agent and later divorce, their authority ends automatically unless you later remarry each other, which reinstates their authority.

9. 9

   Iowa has no central state registry for Durable Powers of Attorney for Health Care and no state-published official form. Keep the signed original and give copies to your physician, your agent, and any alternate agents.

10. 10

    This is a different document from Iowa's Uniform Power of Attorney (Iowa Code Chapter 633B), which covers property and financial decisions, not health care.

Iowa Requirements for Healthcare Power of Attorney

• Designation of Healthcare Agent (Iowa Code Section 144B.1, 144B.5)

  The principal designates an attorney in fact (full name and contact information) to make health care decisions on the principal's behalf. Iowa Code Section 144B.1(1) defines the role, and the optional statutory form at Section 144B.5 contains the designation language;

• Alternate Healthcare Agent (Iowa Code Section 144B.5(4))

  The principal may name one or more alternate attorneys in fact to serve if the primary agent is unable or unwilling to act (Iowa Code Section 144B.5(4)).

• Agent Authority Commencement (Iowa Code Section 144B.1(3), 144B.6(1))

  The attorney in fact's authority to make a particular health care decision exists only if the principal is unable, in the judgment of the attending physician or attending physician assistant, to make that decision; if the principal objects to withholding or withdrawing care, the principal is presumed able to decide (Iowa Code Section 144B.1(3), 144B.6(1)).

• Agent Powers (Iowa Code Section 144B.5, 144B.6)

  The optional statutory form at Iowa Code Section 144B.5 grants the agent power to consent to, refuse, or withdraw consent to health care, and to examine and consent to disclosure of medical records; Section 144B.6 separately gives the attorney in fact priority over any other person, including a court-appointed guardian, to make health care decisions once the principal is unable to decide.

• HIPAA Authorization (45 CFR Section 164.508)

  Federal HIPAA regulations govern how the agent can be authorized to access the principal's protected health information once the document is in effect.

• Life-Sustaining Treatment Decisions (Iowa Code Section 144B.1(4), 144B.5)

  The optional statutory form gives the agent power to consent to a physician or physician assistant not giving, or stopping, health care necessary to keep the principal alive. Iowa Code Section 144B.1(4) defines health care to exclude nutrition or hydration except when it must be provided parenterally or through intubation, which is when the agent's authority over those specific measures applies.

• Organ Donation Authorization (Iowa Code Section 142C.3(1)(b))

  Under Iowa's Revised Uniform Anatomical Gift Act, an agent of the donor may make an anatomical gift for transplantation, therapy, research, or education on the donor's behalf, unless the durable power of attorney for health care or other record prohibits the agent from doing so (Iowa Code Section 142C.3(1)(b)).

• Mental Health Treatment Decisions

  Iowa Code Section 144B.1(4) defines health care broadly enough to include treatment of a mental condition, giving the agent general authority over mental health treatment decisions in the same way as physical health care. However, Chapter 144B never separately mentions mental health treatment or voluntary admission to a mental health facility by name, and Iowa Code Section 229.2, governing voluntary admission, contemplates an application only from the patient personally or, for a minor, a parent, guardian, or custodian; it does not address an attorney in fact applying for an incapacitated adult principal. While an agent has general authority over mental health treatment, Iowa law does not explicitly state whether an agent can apply for voluntary admission to a mental health facility on the principal's behalf.

• Revocation Procedure (Iowa Code Section 144B.8)

  The principal may revoke the durable power of attorney for health care at any time and in any manner communicating that intent, regardless of mental or physical condition, by notifying the attorney in fact or a treating health care provider orally or in writing; the provider must document the revocation in the principal's treatment records once informed (Iowa Code Section 144B.8).

• Witness Requirements (Iowa Code Section 144B.3(1)(b), 144B.3(2), 144B.3(3))

  The principal signs in the presence of two witnesses who also sign in each other's and the principal's presence, or alternatively has the signature acknowledged before a notarial officer, with no witnesses required in that case (Section 144B.3(1)(b)). Neither witness may be a health care provider attending the principal on the date of execution, that provider's employee, the named attorney in fact, or a person under 18 (Section 144B.3(2), applies to both witnesses). Separately, at least one of the two witnesses must not be a relative of the principal by blood, marriage, or adoption within the third degree of consanguinity (Section 144B.3(3), applies to only one witness).

• Notarization Alternative (Iowa Code Section 144B.3(1)(b)(2))

  Iowa law treats notarization as a fully valid alternative to witnessing, not merely an optional extra. The principal may sign and have the signature acknowledged before a notarial officer in Iowa under Iowa Code chapter 9B, in which case no witnesses are required at all (Section 144B.3(1)(b)(2)).

• Agent Consent to Serve (Iowa Code Section 144B.1(1), 144B.5(3))

  Iowa's definition of attorney in fact already requires that the designated person has consented to act in that capacity (Section 144B.1(1)), and the principal may optionally include a statement in the document that the designated attorney in fact has been notified of and consented to the designation (Section 144B.5(3)).

• Agent Liability Limitations (Iowa Code Section 144B.9)

  An attorney in fact is not subject to criminal prosecution or civil liability for a health care decision made in good faith, and good-faith conduct consistent with the principal's known wishes or best interests is presumed absent clear and convincing evidence to the contrary (Iowa Code Section 144B.9).

• Priority Over Guardian (Iowa Code Section 144B.6(1))

  An attorney in fact known to the health care provider to be available and willing to decide has priority over any other person, including a guardian appointed under Iowa Code chapter 633, to make health care decisions for the principal, unless a court finds the attorney in fact is acting contrary to the principal's wishes or the document provides otherwise (Iowa Code Section 144B.6(1)).

• Out-of-State Recognition (Iowa Code Section 144B.3(4))

  A durable power of attorney for health care or similar document validly executed in another state or jurisdiction is deemed valid and enforceable in Iowa to the extent it is consistent with Iowa law; a similar document executed by a veteran in compliance with federal Department of Veterans Affairs advance-directive requirements is likewise deemed valid and enforceable (Iowa Code Section 144B.3(4)).

• Medicare/Medicaid Compliance (42 CFR Section 489.102)

  Facilities participating in Medicare and Medicaid must maintain policies regarding advance directives, including a durable power of attorney for health care, consistent with 42 CFR Section 489.102.

• Patient Self-Determination Act Compliance (42 U.S.C. Section 1395cc(f))

  Facilities that participate in Medicare and Medicaid must inform patients of their rights under state law to make advance directives, including a durable power of attorney for health care.