Iowa Healthcare Power of Attorney Requirements
Iowa is one of the few states where either your attending physician or an attending physician assistant can make the medical judgment that activates your agent's authority, a broader trigger than the physician-only rule many other states use.
Introduction
Iowa is one of the few states where either your attending physician or an attending physician assistant can make the medical judgment that activates your agent's authority, a broader trigger than the physician-only rule many other states use. This document, created under Iowa Code Chapter 144B and known as a Durable Power of Attorney for Health Care (informally, a medical power of attorney), lets you name someone you trust, your attorney in fact or agent, to make health care decisions for you once that judgment is made. Where a financial power of attorney handles money and property, this document is confined to health care decisions. It says nothing about your money, property, or bills, and Iowa's own Uniform Power of Attorney Act expressly excludes health care decisions from its coverage. It also works differently than many people expect: your agent does not gain authority the instant you sign. Your agent can only start deciding for you once your attending physician, or attending physician assistant, judges that you are unable to make your own health care decisions. Until that happens, you keep making your own decisions, and if you ever object to a decision to withhold or withdraw care, Iowa law presumes you are still able to decide. Iowa gives you two ways to make the document legally valid: sign it in front of two qualified witnesses, or sign it before a notarial officer. Iowa law does not require any particular form, and there is no state registry to file it with. Hold onto the original and distribute copies to your physician, your agent, and any alternate agents.
Key Things to Know
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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.
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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)).
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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.
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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).
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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.
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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).
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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.
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If you name your spouse as agent and later divorce, their authority ends automatically unless you later remarry each other, which reinstates their authority.
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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.
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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.
Key decisions before you file
Before you file a Healthcare Power of Attorney in Iowa, a few decisions shape the document: which option to choose and what each one means. The Healthcare Power of Attorney guide walks through them.
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Iowa Requirements for Healthcare Power of Attorney
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;
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)).
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)).
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.
Federal HIPAA regulations govern how the agent can be authorized to access the principal's protected health information once the document is in effect.
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.
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)).
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.
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).
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).
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)).
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)).
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).
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)).
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)).
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.
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.
Frequently Asked Questions
A Durable Power of Attorney for Health Care in Iowa is a legal document, created under Iowa Code Chapter 144B, that lets you name a trusted adult, called your attorney in fact or agent, to make health care decisions for you if you ever become unable to make them yourself. It covers only health care decisions, such as consenting to or refusing treatment and reviewing medical records, and your agent's authority begins only once your attending physician or attending physician assistant judges that you are unable to decide for yourself.
A Durable Power of Attorney for Health Care covers only health care decisions. Iowa's Uniform Power of Attorney Act (Iowa Code Chapter 633B) covers property and financial matters instead, and by its own terms does not apply to health care decisions at all. The two documents also default differently: a Chapter 633B financial power of attorney is durable, meaning it survives your incapacity, unless the document says otherwise, and it requires only notarization to execute. The health care power of attorney has no immediate-effect option at all; your agent's authority always waits for your physician's or physician assistant's judgment that you cannot decide for yourself, and you can execute it with either two witnesses or a notary.
Mostly, but not entirely. Iowa law bars both witnesses from being a health care provider attending you on the date of signing, that provider's employee, your named agent, or someone under 18 (Iowa Code Section 144B.3(2)). On top of that, at least one of the two witnesses must also not be your relative by blood, marriage, or adoption within the third degree of consanguinity, a requirement that applies to only one witness, not both (Section 144B.3(3)).
No. Iowa law bars a health care provider attending you on the date you sign from being designated as your attorney in fact, and the same bar applies to that provider's employee unless the employee is your relative by blood, marriage, or adoption within the third degree of consanguinity (Iowa Code Section 144B.4).
No. Iowa does not operate a central advance-directive registry, and Iowa law does not require any particular state-issued form. You keep the signed original yourself and give copies to your physician, your agent, and any alternate agents so they have it when needed.
You can revoke it at any time and in any manner you are able to communicate that intent, regardless of your mental or physical condition, by telling your agent or a health care provider currently caring for you, orally or in writing, or by signing a later Durable Power of Attorney for Health Care. Revocation takes effect for a given provider only once it is actually communicated to that provider (Iowa Code Section 144B.8).
Iowa law allows another person to sign the instrument on your behalf, as long as that person is acting for you and does so in your presence and at your direction. The document is still valid under Iowa Code Section 144B.3(1)(b)(1) even though it does not carry your own handwritten signature.
The power is automatically revoked once the marriage between you and your spouse-agent is dissolved. If you later remarry each other, the power is reinstated unless you have otherwise revoked it (Iowa Code Section 144B.12(3)).