Health care directive in North Carolina: form, signing and who decides
The form, who can witness, who can be your agent and who decides if you have no directive in North Carolina.
Checked against official sources: October 31, 2026.
Short answer
Health Care Power of Attorney
- Official form
- Health Care Power of Attorney
- How to sign
- Notarized and signed in front of two witnesses
- Who decides without a directive
- Yes
The document and its form
- Document
- Health Care Power of Attorney
- Official form
- Health Care Power of Attorney (statutory form, G.S. 32A-25.1)Published by North Carolina Secretary of StateVersion: Rev. 07-08-2022
You do not have to use it.
- Living will
Advance Directive for a Natural Death ('Living Will')
The living will is a separate document.
A living will tells your doctors to withhold or stop life-prolonging measures if you have an incurable condition that will cause death within a short time, are permanently unconscious, or have advanced dementia or similar irreversible loss of thinking ability, as you choose. Two physicians must confirm your condition. It must be signed in front of two qualified witnesses (same rules as for the health care power of attorney) and proved before a notary public or a clerk or assistant clerk of superior court. The Secretary of State's form is Rev. 07-08-2022.
Law: N.C. Gen. Stat. § 32A-25.1; N.C. Gen. Stat. § 90-321
Signing rules
- How to sign
Sign the health care power of attorney in front of two qualified witnesses and acknowledge it before a notary public. Both witnesses and a notary are required.
- Who signs
Signed by you (or by another person at your direction in your presence, per the statutory form's witness statement).
- Notary
- Required
- Witnesses
- 2
- Who cannot witness
Each of the two witnesses must believe you are of sound mind and state that they are not related within the third degree to you or your spouse; would not inherit from you under a will or by law; are not your attending physician or mental health treatment provider, a licensed health care provider employed by them, or a paid employee of a health facility where you are a patient or of a nursing home or adult care home where you live; and have no claim against your estate. The notary may be an employee of those providers or facilities.
- Nursing facilities and special settings
Paid employees of a nursing home or adult care home where you live cannot be witnesses, but the notary can be one.
Law: N.C. Gen. Stat. § 32A-16(3), (6)
Who can be your agent and what the agent can do
- Who cannot be your agent
Any competent person 18 or older who is not providing health care to you for pay.
Law: G.S. 32A-18
- When the agent starts
The health care power of attorney takes effect when the physician you designated (or, if none, your attending physician; for mental health treatment, a physician or eligible psychologist) determines in writing that you lack capacity to make or communicate health care decisions, and continues during your incapacity.
Law: G.S. 32A-20(a)
- Decisions an agent cannot make
The agent has only the health care powers in the document and no general authority over your property. Agent decisions on mental health treatment must follow any advance instruction for mental health treatment. A health care agent cannot revoke your living will unless the health care power of attorney explicitly allows it.
Law: G.S. 32A-19, 90-321(e)
Revoking and conflicting documents
- Revoking your agent
While you can make and communicate health care decisions, you can revoke a health care power of attorney by signing and acknowledging a revocation, by signing and acknowledging a new health care power of attorney, or in any other way you can communicate your intent. The revocation takes effect only when you communicate it to each health care agent named and to your attending physician or eligible psychologist.
- Revoking your instructions
You can revoke a living will in writing or in any way you can clearly and consistently communicate your intent, whatever your mental or physical condition.
- Telling others
Providers are protected if they act on a revoked document without actual notice of the revocation. To remove a document from the Secretary of State's registry, the revocation must be notarized.
Law: G.S. 130A-466(b)
- Divorce ends a spouse's authority
- Yes · Divorce rules in North Carolina (Divorce Law Map)
- Conflicting documents
A health care power of attorney and living will can be combined into one document if it meets the signing rules of both.
Law: G.S. 32A-26, 90-321(j)
Law: N.C. Gen. Stat. §§ 32A-20(b), (c), 90-321(e)
If you have no directive
- Who decides without a directive
If you have no living will and your attending physician (confirmed in writing by another physician) finds you will never regain capacity and you have an incurable condition that will soon cause death or are permanently unconscious, life-prolonging measures may be withheld or stopped with the agreement of the first available person in this order. If none is available, the attending physician may decide.
- A court-appointed guardian of the person or general guardian (a health care agent keeps the authority granted unless the clerk suspends it)
- A health care agent
- Another agent with health care powers you appointed
- Your spouse
- A majority of your reasonably available parents and adult children
- A majority of your reasonably available adult siblings
- An individual with an established relationship with you who acts in good faith and can reliably convey your wishes
Law: N.C. Gen. Stat. § 90-322
Other states, registry and medical orders
- Signed in another state
A health care power of attorney or living will signed in another state is valid in North Carolina if it appears to follow that state's rules or North Carolina's.
Law: G.S. 32A-27, 90-321(l)
- Registry
Advance Health Care Directive Registry (North Carolina Secretary of State)
Fee: $10 to file a document; no fee to file a revocation. Documents and revocations filed must be notarized.
Law: G.S. 130A-470
- POLST (medical orders)
Medical Order for Scope of Treatment (MOST) and portable DNR order (forms developed by the N.C. Department of Health and Human Services)
- Mental health directive
You can make an advance instruction for mental health treatment. It must be signed in front of two qualified witnesses and acknowledged before a notary. It can be combined with a health care power of attorney and can nominate a guardian of the person. The Secretary of State publishes a form: https://www.sosnc.gov/webfiles/documents/forms/advance_healthcare_directives/advance_instruction_for_mental_health.pdf
Law: G.S. 122C-72, 122C-73, 32A-19(a1)
Law: N.C. Gen. Stat. §§ 130A-465 to 130A-470; N.C. Gen. Stat. § 90-21.17
Free notice: revoke or change a health care directive
Free help in North Carolina
- Legal Aid of North Carolina
- N.C. Judicial Branch: Guardianship
- N.C. Secretary of State: Advance health care directive forms
- N.C. Secretary of State: Advance Health Care Directive Registry
- Find free legal aid at LawHelp.org
Report abuse or exploitation
Questions about powers of attorney in North Carolina
How do I sign a health care directive in North Carolina?
Sign the health care power of attorney in front of two qualified witnesses and acknowledge it before a notary public. Both witnesses and a notary are required.
Who decides my health care if I have no directive in North Carolina?
If you have no living will and your attending physician (confirmed in writing by another physician) finds you will never regain capacity and you have an incurable condition that will soon cause death or are permanently unconscious, life-prolonging measures may be withheld or stopped with the agreement of the first available person in this order.