Sit down with the competent principal who wants to name you as her agent, to draw up the power. Entitle the document "Power of Attorney" to leave no doubt as to its purpose.
Add the statutory notice that appears in Title 20, Section 5601(c) of the Pennsylvania Consolidated Statutes. This notice must be printed in all capital letters and must be placed at the beginning of the document. The notice explains your powers and duties as agent. Inclusion of the notice is unnecessary if the your authority is limited to health care decision making.
Identify the principal and you, as the agent, by full legal names and addresses and state that the principal hereby grants power of attorney to the agent to perform the legal acts listed in the document. Although the agent is sometimes referred to as the "attorney-in-fact," you don't have to be an attorney to serve as agent. You can also share the duties with a co-agent.
Discuss with the principal the specific legal acts that she wants to give you authority to perform on her behalf and specify them in the document. Although it is possible for the principal to authorize you to perform any legal act that she is entitled to perform, such a broad grant of authority is seldom used.
State the beginning and ending dates of your authority, if any, as discussed with the principal. If you don't list beginning and ending dates, your authority will begin as soon as the document is signed and will endure until the principal dies or revokes your authority. If the principal so desires, you may draft the document to state that your authority begins only when the principal is mentally incompetent or unable to communicate and ends whenever she regains these abilities.
Add the statutory language set forth in Title 20, Section 5601(d) of the Pennsylvania Consolidated Statutes. This language constitutes your acceptance of the appointment and explains your fiduciary duties toward the principal. Inclusion of this language is unnecessary if your authority is limited to health care decision making.
Sign and date the power of attorney and have the principal do the same. You don't have to sign or date it if your authority is limited to health care decision making. If the principal is unable to sign the document, she may authorize a third party, who is not the agent, to sign on her behalf. In this case, two people at least 18 years of age must witness the signing.