Medical Power of Attorney for Overseas Travel

Principal Information

Full Name
Date of Birth
Passport Number
Address Phone Number

Agent Information (Person Granted Medical Power of Attorney)

Agent's Full Name
Relationship to Principal
Phone Number
Agent's Address

Travel Details

Destination Country
Departure Date
Return Date

Authorization

I, the undersigned Principal, hereby appoint the above-named Agent to make decisions regarding my medical care and treatment in the event I am unable to do so during my overseas travel.

This Medical Power of Attorney is effective for the duration of my travel as mentioned above.

Special Instructions (If Any)

Principal's Signature Date
Witness/Notary Signature Date