Durable Power of Attorney (DPA) 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.

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.

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

  • 100 & above = $.60/set
  • 11 - 99 = $.65/set
  • 2 - 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

* For 2-10 sets, please order by mail or phone.

To order your forms and brochures online, use the form below.

To order your forms and brochures by mail, click here.

To order your forms by phone, call Katrina Hill at 517-336-5727

For more information about Durable Power of Attorney for Health Care, contact Katrina Hill at 517-336-5727.

 

Sales Tax Exemption

If MSMS does not yet have your Certificate of Exemption on file, continue submitting your order here, but you must download, fill out and email or fax the Michigan Sales Tax Certificate of Exemption form to us before we can process your order. Fax to: 517-337-2490 or email to: dpa.forms@msms.org.

Contact Information

Bill To

Ship To

Order Information

Sets (1 Set = 1 Form and 1 Brochure)

Quantity 20-99 at $0.65 per set / Quantity 100+ at $0.60 per set

Set Cost: $ 0.00

Forms Only

Quantity 20-99 at $0.60 each / Quantity 100+ at $0.35 each

Form Cost: $ 0.00

Brochures

Quantity 20-99 at $0.60 per set / Quantity 100+ at $0.35 per set

Brochure Cost: $ 0.00

Total

Subtotal: $0.00
Sales Tax: $0.00
Grand Total: $0.00

Payment Information