VIC Appointment of Medical Treatment Decision Maker – (Short Form)[Someone signing on your behalf]

This document follows the format of the form approved by the Department of Health and Human Services of Victoria for the appointment of Medical Treatment Decision Makers pursuant to the Medical Treatment Planning and Decisions Act 2016 (VIC).

Use this document as follows:

1️⃣ Use this document if the Appointor is unable to sign for themselves and will direct another person to sign on their behalf and in their presence.

2️⃣ Appoint up to 2 Medical Treatment Decision Makers to make medical treatment decisions if the Appointor is unable to do so for themselves.

3️⃣ Authorise all the powers of a Medical Treatment Decision Maker to make medical treatment decisions or impose limitations or conditions in the appointment.

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