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1		AN ACT concerning civil law.
2		Be it enacted by the People of the State of Illinois,
3		represented in the General Assembly:
4		Section 5. The Illinois Power of Attorney Act is amended by
5		changing Sections 4-5.1 and 4-10 as follows:
6		(755 ILCS 45/4-5.1)
7		Sec. 4-5.1. Limitations on who may witness health care
8		agencies.
9		(a) Every health care agency shall bear the signature of a
10		witness to the signing of the agency. No witness may be under
11		18 years of age. None of the following licensed professionals
12		providing services to the principal may serve as a witness to
13		the signing of a health care agency:
14		(1) the attending physician, advanced practice nurse,
15		physician assistant, dentist, podiatric physician,
16		optometrist, or psychologist mental health service
17		provider of the principal, or a relative of the physician,
18		advanced practice nurse, physician assistant, dentist,
19		podiatric physician, optometrist, or psychologist mental
20		health service provider;
21		(2) an owner, operator, or relative of an owner or
22		operator of a health care facility in which the principal
23		is a patient or resident;

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1		(3) a parent, sibling, or descendant, or the spouse of
2		a parent, sibling, or descendant, of either the principal
3		or any agent or successor agent, regardless of whether the
4		relationship is by blood, marriage, or adoption;
5		(4) an agent or successor agent for health care.
6		(b) The prohibition on the operator of a health care
7		facility from serving as a witness shall extend to directors
8		and executive officers of an operator that is a corporate
9		entity but not other employees of the operator such as, but not
10		limited to, non-owner chaplains or social workers, nurses, and
11		other employees.
12		(Source: P.A. 98-1113, eff. 1-1-15.)
13		(755 ILCS 45/4-10) (from Ch. 110 1/2, par. 804-10)
14		Sec. 4-10. Statutory short form power of attorney for
15		health care.
16		(a) The form prescribed in this Section (sometimes also
17		referred to in this Act as the "statutory health care power")
18		may be used to grant an agent powers with respect to the
19		principal's own health care; but the statutory health care
20		power is not intended to be exclusive nor to cover delegation
21		of a parent's power to control the health care of a minor
22		child, and no provision of this Article shall be construed to
23		invalidate or bar use by the principal of any other or
24		different form of power of attorney for health care.
25		Nonstatutory health care powers must be executed by the

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1		principal, designate the agent and the agent's powers, and
2		comply with the limitations in Section 4-5 of this Article, but
3		they need not be witnessed or conform in any other respect to
4		the statutory health care power.
5		No specific format is required for the statutory health
6		care power of attorney other than the notice must precede the
7		form. The statutory health care power may be included in or
8		combined with any other form of power of attorney governing
9		property or other matters.
10		(b) The Illinois Statutory Short Form Power of Attorney for
11		Health Care shall be substantially as follows:
12		NOTICE TO THE INDIVIDUAL SIGNING
13		THE POWER OF ATTORNEY FOR HEALTH CARE
14		No one can predict when a serious illness or accident might
15		occur. When it does, you may need someone else to speak or make
16		health care decisions for you. If you plan now, you can
17		increase the chances that the medical treatment you get will be
18		the treatment you want.
19		In Illinois, you can choose someone to be your "health care
20		agent". Your agent is the person you trust to make health care
21		decisions for you if you are unable or do not want to make them
22		yourself. These decisions should be based on your personal
23		values and wishes.
24		It is important to put your choice of agent in writing. The
25		written form is often called an "advance directive". You may

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1		use this form or another form, as long as it meets the legal
2		requirements of Illinois. There are many written and on-line
3		resources to guide you and your loved ones in having a
4		conversation about these issues. You may find it helpful to
5		look at these resources while thinking about and discussing
6		your advance directive.
7		WHAT ARE THE THINGS I WANT MY
8		HEALTH CARE AGENT TO KNOW?
9		The selection of your agent should be considered carefully,
10		as your agent will have the ultimate decision making authority
11		once this document goes into effect, in most instances after
12		you are no longer able to make your own decisions. While the
13		goal is for your agent to make decisions in keeping with your
14		preferences and in the majority of circumstances that is what
15		happens, please know that the law does allow your agent to make
16		decisions to direct or refuse health care interventions or
17		withdraw treatment. Your agent will need to think about
18		conversations you have had, your personality, and how you
19		handled important health care issues in the past. Therefore, it
20		is important to talk with your agent and your family about such
21		things as:
22		(i) What is most important to you in your life?
23		(ii) How important is it to you to avoid pain and
24		suffering?
25		(iii) If you had to choose, is it more important to you

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1		to live as long as possible, or to avoid prolonged
2		suffering or disability?
3		(iv) Would you rather be at home or in a hospital for
4		the last days or weeks of your life?
5		(v) Do you have religious, spiritual, or cultural
6		beliefs that you want your agent and others to consider?
7		(vi) Do you wish to make a significant contribution to
8		medical science after your death through organ or whole
9		body donation?
10		(vii) Do you have an existing advanced directive, such
11		as a living will, that contains your specific wishes about
12		health care that is only delaying your death? If you have
13		another advance directive, make sure to discuss with your
14		agent the directive and the treatment decisions contained
15		within that outline your preferences. Make sure that your
16		agent agrees to honor the wishes expressed in your advance
17		directive.
18		WHAT KIND OF DECISIONS CAN MY AGENT MAKE?
19		If there is ever a period of time when your physician
20		determines that you cannot make your own health care decisions,
21		or if you do not want to make your own decisions, some of the
22		decisions your agent could make are to:
23		(i) talk with physicians and other health care
24		providers about your condition.
25		(ii) see medical records and approve who else can see

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1		them.
2		(iii) give permission for medical tests, medicines,
3		surgery, or other treatments.
4		(iv) choose where you receive care and which physicians
5		and others provide it.
6		(v) decide to accept, withdraw, or decline treatments
7		designed to keep you alive if you are near death or not
8		likely to recover. You may choose to include guidelines
9		and/or restrictions to your agent's authority.
10		(vi) agree or decline to donate your organs or your
11		whole body if you have not already made this decision
12		yourself. This could include donation for transplant,
13		research, and/or education. You should let your agent know
14		whether you are registered as a donor in the First Person
15		Consent registry maintained by the Illinois Secretary of
16		State or whether you have agreed to donate your whole body
17		for medical research and/or education.
18		(vii) decide what to do with your remains after you
19		have died, if you have not already made plans.
20		(viii) talk with your other loved ones to help come to
21		a decision (but your designated agent will have the final
22		say over your other loved ones).
23		Your agent is not automatically responsible for your health
24		care expenses.
25		WHOM SHOULD I CHOOSE TO BE MY HEALTH CARE AGENT?

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1		You can pick a family member, but you do not have to. Your
2		agent will have the responsibility to make medical treatment
3		decisions, even if other people close to you might urge a
4		different decision. The selection of your agent should be done
5		carefully, as he or she will have ultimate decision-making
6		authority for your treatment decisions once you are no longer
7		able to voice your preferences. Choose a family member, friend,
8		or other person who:
9		(i) is at least 18 years old;
10		(ii) knows you well;
11		(iii) you trust to do what is best for you and is
12		willing to carry out your wishes, even if he or she may not
13		agree with your wishes;
14		(iv) would be comfortable talking with and questioning
15		your physicians and other health care providers;
16		(v) would not be too upset to carry out your wishes if
17		you became very sick; and
18		(vi) can be there for you when you need it and is
19		willing to accept this important role.
20		WHAT IF MY AGENT IS NOT AVAILABLE OR IS
21		UNWILLING TO MAKE DECISIONS FOR ME?
22		If the person who is your first choice is unable to carry
23		out this role, then the second agent you chose will make the
24		decisions; if your second agent is not available, then the
25		third agent you chose will make the decisions. The second and

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1		third agents are called your successor agents and they function
2		as back-up agents to your first choice agent and may act only
3		one at a time and in the order you list them.
4		WHAT WILL HAPPEN IF I DO NOT
5		CHOOSE A HEALTH CARE AGENT?
6		If you become unable to make your own health care decisions
7		and have not named an agent in writing, your physician and
8		other health care providers will ask a family member, friend,
9		or guardian to make decisions for you. In Illinois, a law
10		directs which of these individuals will be consulted. In that
11		law, each of these individuals is called a "surrogate".
12		There are reasons why you may want to name an agent rather
13		than rely on a surrogate:
14		(i) The person or people listed by this law may not be
15		who you would want to make decisions for you.
16		(ii) Some family members or friends might not be able
17		or willing to make decisions as you would want them to.
18		(iii) Family members and friends may disagree with one
19		another about the best decisions.
20		(iv) Under some circumstances, a surrogate may not be
21		able to make the same kinds of decisions that an agent can
22		make.
23		WHAT IF THERE IS NO ONE AVAILABLE
24		WHOM I TRUST TO BE MY AGENT?

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1		In this situation, it is especially important to talk to
2		your physician and other health care providers and create
3		written guidance about what you want or do not want, in case
4		you are ever critically ill and cannot express your own wishes.
5		You can complete a living will. You can also write your wishes
6		down and/or discuss them with your physician or other health
7		care provider and ask him or her to write it down in your
8		chart. You might also want to use written or on-line resources
9		to guide you through this process.
10		WHAT DO I DO WITH THIS FORM ONCE I COMPLETE IT?
11		Follow these instructions after you have completed the
12		form:
13		(i) Sign the form in front of a witness. See the form
14		for a list of who can and cannot witness it.
15		(ii) Ask the witness to sign it, too.
16		(iii) There is no need to have the form notarized.
17		(iv) Give a copy to your agent and to each of your
18		successor agents.
19		(v) Give another copy to your physician.
20		(vi) Take a copy with you when you go to the hospital.
21		(vii) Show it to your family and friends and others who
22		care for you.
23		WHAT IF I CHANGE MY MIND?
24		You may change your mind at any time. If you do, tell

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1		someone who is at least 18 years old that you have changed your
2		mind, and/or destroy your document and any copies. If you wish,
3		fill out a new form and make sure everyone you gave the old
4		form to has a copy of the new one, including, but not limited
5		to, your agents and your physicians.
6		WHAT IF I DO NOT WANT TO USE THIS FORM?
7		In the event you do not want to use the Illinois statutory
8		form provided here, any document you complete must be executed
9		by you, designate an agent who is over 18 years of age and not
10		prohibited from serving as your agent, and state the agent's
11		powers, but it need not be witnessed or conform in any other
12		respect to the statutory health care power.
13		If you have questions about the use of any form, you may
14		want to consult your physician, other health care provider,
15		and/or an attorney.
16		MY POWER OF ATTORNEY FOR HEALTH CARE
17		THIS POWER OF ATTORNEY REVOKES ALL PREVIOUS POWERS OF ATTORNEY
18		FOR HEALTH CARE. (You must sign this form and a witness must
19		also sign it before it is valid)
20		My name (Print your full name):..........
21		My address:..................................................

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1		I WANT THE FOLLOWING PERSON TO BE MY HEALTH CARE AGENT
2		(an agent is your personal representative under state and
3		federal law):
4		(Agent name).................
5		(Agent address).............
6		(Agent phone number).........................................
7		(Please check box if applicable) .... If a guardian of my
8		person is to be appointed, I nominate the agent acting under
9		this power of attorney as guardian.
10		SUCCESSOR HEALTH CARE AGENT(S) (optional):
11		If the agent I selected is unable or does not want to make
12		health care decisions for me, then I request the person(s) I
13		name below to be my successor health care agent(s). Only one
14		person at a time can serve as my agent (add another page if you
15		want to add more successor agent names):
16		.............................................................
17		(Successor agent #1 name, address and phone number)
18		.............................................................
19		(Successor agent #2 name, address and phone number)
20		MY AGENT CAN MAKE HEALTH CARE DECISIONS FOR ME, INCLUDING:
21		(i) Deciding to accept, withdraw or decline treatment
22		for any physical or mental condition of mine, including
23		life-and-death decisions.

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1		(ii) Agreeing to admit me to or discharge me from any
2		hospital, home, or other institution, including a mental
3		health facility.
4		(iii) Having complete access to my medical and mental
5		health records, and sharing them with others as needed,
6		including after I die.
7		(iv) Carrying out the plans I have already made, or, if
8		I have not done so, making decisions about my body or
9		remains, including organ, tissue or whole body donation,
10		autopsy, cremation, and burial.
11		The above grant of power is intended to be as broad as
12		possible so that my agent will have the authority to make any
13		decision I could make to obtain or terminate any type of health
14		care, including withdrawal of nutrition and hydration and other
15		life-sustaining measures.
16		I AUTHORIZE MY AGENT TO (please check any one box):
17		.... Make decisions for me only when I cannot make them for
18		myself. The physician(s) taking care of me will determine
19		when I lack this ability.
20		(If no box is checked, then the box above shall be
21		implemented.) OR
22		.... Make decisions for me only when I cannot make them for
23		myself. The physician(s) taking care of me will determine
24		when I lack this ability. Starting now, my agent shall have
25		complete access to my medical and mental health records,

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1		the authority to share them with others as needed, and the
2		complete ability to communicate with my personal
3		physician(s) and other health care providers, including
4		the ability to require an opinion of my physician as to
5		whether I lack the ability to make decisions for myself. OR
6		.... Make decisions for me starting now and continuing
7		after I am no longer able to make them for myself. While I
8		am still able to make my own decisions, I can still do so
9		if I want to, but want my agent to be consulted, if
10		available.
11		The subject of life-sustaining treatment is of particular
12		importance. Life-sustaining treatments may include tube
13		feedings or fluids through a tube, breathing machines, and CPR.
14		In general, in making decisions concerning life-sustaining
15		treatment, your agent is instructed to consider the relief of
16		suffering, the quality as well as the possible extension of
17		your life, and your previously expressed wishes. Your agent
18		will weigh the burdens versus benefits of proposed treatments
19		in making decisions on your behalf.
20		Additional statements concerning the withholding or
21		removal of life-sustaining treatment are described below.
22		These can serve as a guide for your agent when making decisions
23		for you. Ask your physician or health care provider if you have
24		any questions about these statements.

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1		SELECT ONLY ONE STATEMENT BELOW THAT BEST EXPRESSES YOUR WISHES
2		(optional):
3		.... The quality of my life is more important than the
4		length of my life. If I am unconscious and my attending
5		physician believes, in accordance with reasonable medical
6		standards, that I will not wake up or recover my ability to
7		think, communicate with my family and friends, and
8		experience my surroundings, I do not want treatments to
9		prolong my life or delay my death, but I do want treatment
10		or care to make me comfortable and to relieve me of pain.
11		.... Staying alive is more important to me, no matter how
12		sick I am, how much I am suffering, the cost of the
13		procedures, or how unlikely my chances for recovery are. I
14		want my life to be prolonged to the greatest extent
15		possible in accordance with reasonable medical standards.
16		SPECIFIC LIMITATIONS TO MY AGENT'S DECISION-MAKING AUTHORITY:
17		The above grant of power is intended to be as broad as
18		possible so that your agent will have the authority to make any
19		decision you could make to obtain or terminate any type of
20		health care. If you wish to limit the scope of your agent's
21		powers or prescribe special rules or limit the power to
22		authorize autopsy or dispose of remains, you may do so
23		specifically in this form.
24		..................................
25		..............................

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1		My signature:..................
2		Today's date:................................................
3		HAVE YOUR WITNESS AGREE TO WHAT IS WRITTEN BELOW, AND THEN
4		COMPLETE THE SIGNATURE PORTION:
5		I am at least 18 years old. (check one of the options
6		below):
7		.... I saw the principal sign this document, or
8		.... the principal told me that the signature or mark on
9		the principal signature line is his or hers.
10		I am not the agent or successor agent(s) named in this
11		document. I am not related to the principal, the agent, or the
12		successor agent(s) by blood, marriage, or adoption. I am not
13		the principal's physician, advanced practice nurse, dentist,
14		podiatric physician, optometrist, psychologist mental health
15		service provider, or a relative of one of those individuals. I
16		am not an owner or operator (or the relative of an owner or
17		operator) of the health care facility where the principal is a
18		patient or resident.
19		Witness printed name:............
20		Witness address:..............
21		Witness signature:...............
22		Today's date:................................................
23		SUCCESSOR HEALTH CARE AGENT(S) (optional):

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1		If the agent I selected is unable or does not want to make
2		health care decisions for me, then I request the person(s) I
3		name below to be my successor health care agent(s). Only one
4		person at a time can serve as my agent (add another page if you
5		want to add more successor agent names):
6		.............................................................
7		(Successor agent #1 name, address and phone number)
8		.............................................................
9		(Successor agent #2 name, address and phone number)
10		(c) The statutory short form power of attorney for health
11		care (the "statutory health care power") authorizes the agent
12		to make any and all health care decisions on behalf of the
13		principal which the principal could make if present and under
14		no disability, subject to any limitations on the granted powers
15		that appear on the face of the form, to be exercised in such
16		manner as the agent deems consistent with the intent and
17		desires of the principal. The agent will be under no duty to
18		exercise granted powers or to assume control of or
19		responsibility for the principal's health care; but when
20		granted powers are exercised, the agent will be required to use
21		due care to act for the benefit of the principal in accordance
22		with the terms of the statutory health care power and will be
23		liable for negligent exercise. The agent may act in person or
24		through others reasonably employed by the agent for that
25		purpose but may not delegate authority to make health care

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1		decisions. The agent may sign and deliver all instruments,
2		negotiate and enter into all agreements and do all other acts
3		reasonably necessary to implement the exercise of the powers
4		granted to the agent. Without limiting the generality of the
5		foregoing, the statutory health care power shall include the
6		following powers, subject to any limitations appearing on the
7		face of the form:
8		(1) The agent is authorized to give consent to and
9		authorize or refuse, or to withhold or withdraw consent to,
10		any and all types of medical care, treatment or procedures
11		relating to the physical or mental health of the principal,
12		including any medication program, surgical procedures,
13		life-sustaining treatment or provision of food and fluids
14		for the principal.
15		(2) The agent is authorized to admit the principal to
16		or discharge the principal from any and all types of
17		hospitals, institutions, homes, residential or nursing
18		facilities, treatment centers and other health care
19		institutions providing personal care or treatment for any
20		type of physical or mental condition. The agent shall have
21		the same right to visit the principal in the hospital or
22		other institution as is granted to a spouse or adult child
23		of the principal, any rule of the institution to the
24		contrary notwithstanding.
25		(3) The agent is authorized to contract for any and all
26		types of health care services and facilities in the name of

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1		and on behalf of the principal and to bind the principal to
2		pay for all such services and facilities, and to have and
3		exercise those powers over the principal's property as are
4		authorized under the statutory property power, to the
5		extent the agent deems necessary to pay health care costs;
6		and the agent shall not be personally liable for any
7		services or care contracted for on behalf of the principal.
8		(4) At the principal's expense and subject to
9		reasonable rules of the health care provider to prevent
10		disruption of the principal's health care, the agent shall
11		have the same right the principal has to examine and copy
12		and consent to disclosure of all the principal's medical
13		records that the agent deems relevant to the exercise of
14		the agent's powers, whether the records relate to mental
15		health or any other medical condition and whether they are
16		in the possession of or maintained by any physician,
17		psychiatrist, psychologist, therapist, hospital, nursing
18		home or other health care provider. The authority under
19		this paragraph (4) applies to any information governed by
20		the Health Insurance Portability and Accountability Act of
21		1996 ("HIPAA") and regulations thereunder. The agent
22		serves as the principal's personal representative, as that
23		term is defined under HIPAA and regulations thereunder.
24		(5) The agent is authorized: to direct that an autopsy
25		be made pursuant to Section 2 of "An Act in relation to
26		autopsy of dead bodies", approved August 13, 1965,

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1		including all amendments; to make a disposition of any part
2		or all of the principal's body pursuant to the Illinois
3		Anatomical Gift Act, as now or hereafter amended; and to
4		direct the disposition of the principal's remains.
5		(6) At any time during which there is no executor or
6		administrator appointed for the principal's estate, the
7		agent is authorized to continue to pursue an application or
8		appeal for government benefits if those benefits were
9		applied for during the life of the principal.
10		(d) A physician may determine that the principal is unable
11		to make health care decisions for himself or herself only if
12		the principal lacks decisional capacity, as that term is
13		defined in Section 10 of the Health Care Surrogate Act.
14		(e) If the principal names the agent as a guardian on the
15		statutory short form, and if a court decides that the
16		appointment of a guardian will serve the principal's best
17		interests and welfare, the court shall appoint the agent to
18		serve without bond or security. If appointed hereunder, the
19		court appointed guardian shall be the legal health care
20		decision maker for the principal.
21		(Source: P.A. 97-148, eff. 7-14-11; 98-1113, eff. 1-1-15.)