Home Health Care Delivery Order Health Care Forms

You can now decide IN ADVANCE about your health care

Health care and legal groups urge every Michigan resident over 18 years old to complete a Durable Power of Attorney for Health Care Designation Form. The forms were developed and approved by the Michigan State Medical Society, the State Bar of Michigan, the Michigan Health and Hospital Association, and the Michigan Osteopathic Association.

The Designation Form is an eight-page booklet. The document is designed to be a 'user friendly' form. The form provides a patient with the means to appoint a patient advocate to make health care decisions for them if they become incapacitated. The short patient brochure accompanying each form covers more detailed information about the new Durable Power of Attorney for Health Care law.

Due to increased printing costs, shipping and handling, and the state requirement for sales tax, MSMS is increasing the prices of the Durable Power of Attorney forms & brochures.  This is the first price increase in 22 years, so we hope you will not find it burdensome.

For those organizations that are sales tax exempt there is a Sales Tax Exemption form included with the order form that must be filled out before the order can be processed.  If your organization is not sales tax exempt, the 6% state sales tax will need to be calculated into your order's total amount.

Forms and brochures are sold either separately or as a set (a set is considered one form and one brochure).  There are 600 forms to a box and 1500 brochures to a box. 

When sold in sets the pricing per designated quantity is as follows:

• 100 & above = $.60/set
• 11 – 99 = $.65/set
• 1 – 10 = $2.00/set (we require a minimum of two sets to be ordered)

When sold separately the pricing per designated quantity is as follows:

• 100 & above (forms or brochures) = $.35/form or brochure
• 20 – 99 (forms or brochures) = $.60/form or brochure

To order your forms and brochures online, click here.
To order your forms and brochures by mail, or fax, click here.
To order your forms by phone, call Heather Hill at 517-336-5772

For more information about Durable Power of Attorney for Health Care, contact David K. Fox at 517-336-5731, or dkfox@msms.org