Lasting Power of Attorney (Health and Welfare) — Word & PDF Template

This Lasting Power of Attorney for Health and Welfare lets a donor appoint one or more attorneys to make decisions about their care and medical treatment if they lose the mental capacity to decide for themselves. It is prepared for use in England and Wales under the Mental Capacity Act 2005.

Who is this template for?

For anyone who wishes to plan ahead and choose trusted people to make health and welfare decisions on their behalf, and for families helping a relative put their affairs in order.

What does the template include?

The document is organised into clear sections:

• Important Notice — how the LPA works and the need to register it.
• The Donor — the person granting the power.
• Attorney(s) — the people appointed to act.
• How Attorneys Act — jointly or jointly and severally.
• Replacement Attorney(s) — back-up attorneys.
• Life-Sustaining Treatment — whether attorneys may decide on this.
• Scope of Attorney’s Powers — the decisions they can make.
• Restrictions and Guidance — limits and preferences.
• Certificate Provider — confirmation of understanding.
• People to Notify — those told about registration.
• Registration — registering with the Office of the Public Guardian.
• Signatures — signing by the donor, attorneys and witnesses.

Easy to customise

The template works in Microsoft Word, Google Docs and LibreOffice. Fill in the highlighted fields, choose your options on treatment and restrictions, and follow the signing guidance. The completed LPA must be registered with the Office of the Public Guardian before it can be used.

Format and scope

Provided as an editable Word (.docx) file and a ready-to-print PDF in A4 size, drafted for use in England and Wales.