Last reviewed: 10/02/2023
Using this Document
A Financial Power of Attorney (POA) is a legal document that allows an individual (the “principal”) to appoint another person (the “agent” or “attorney-in-fact”) to manage their financial affairs and make financial decisions on their behalf. While a Financial POA itself isn’t typically subject to the Health Insurance Portability and Accountability Act (HIPAA), it may involve access to the principal’s financial information.
Please note that the requirements for a Financial Power of Attorney and the need for witnesses may vary by state. It’s crucial to consult with legal counsel or a financial professional in your area to ensure that your Financial Power of Attorney is compliant with your state’s laws and regulations. Additionally, it’s advisable to discuss your preferences and financial goals with your financial agent to ensure they are aware of your wishes and responsibilities.
Here’s a template for a Financial Power of Attorney that incorporates HIPAA compliance considerations:
Financial Power of Attorney and HIPAA Authorization
Principal Information:
- Full Name: ________________________________
- Date of Birth: ________________________________
- Address: ________________________________
- City: ________________________________
- State: ________________________________
- Zip Code: ________________________________
- Phone Number: ________________________________
Financial Agent Information:
- Name of Financial Agent: ________________________________
- Relationship to Principal: ________________________________
- Address of Financial Agent (if applicable): ________________________________
- City: ________________________________
- State: ________________________________
- Zip Code: ________________________________
- Phone Number: ________________________________
Authorization of Financial Agent: I, [Principal’s Full Name], hereby appoint [Financial Agent’s Full Name] as my financial agent to manage my financial affairs and make financial decisions on my behalf. This authority includes the ability to access and manage my financial information, including bank accounts, investments, and other assets.
Scope of Authority: My financial agent’s authority shall include, but not be limited to, the following:
- To manage my bank accounts, including deposits, withdrawals, and transfers.
- To manage my investments, including buying, selling, and trading securities.
- To pay bills and expenses on my behalf.
- To access and manage my financial records, including account statements and tax information.
HIPAA Authorization: I authorize financial institutions, tax authorities, and other relevant entities to disclose my financial information to my financial agent for the purpose of managing my financial affairs. This authorization complies with the requirements of the Health Insurance Portability and Accountability Act (HIPAA) to the extent it applies to financial information.
Duration and Revocation: This Financial Power of Attorney shall remain in effect until I revoke it in writing or until my death. I understand that I have the right to revoke or change this Financial Power of Attorney at any time.
Signature: I have signed this Financial Power of Attorney willingly and in full understanding of its implications on this [Date].
Principal’s Signature: ________________________________
Witnesses (if required by state law):
- Name: ________________________________ Signature: ________________________________ Date: ________________________________
- Name: ________________________________ Signature: ________________________________ Date: ________________________________