VA Form 10-0137, VA Advance Directive: Durable Power of Attorney for Health Care and Living Will, is a Power of Attorney (POA) form used by the Department of Veterans Affairs (VA). This form is used to designate a health care representative that will be able to act on behalf of the person in case they will no longer be able to make decisions themselves. The information provided on this form can be changed or canceled anytime, as long as the individual is well and of sound mind.
Alternate Name:
The latest version of the form was released on May 1, 2018, with all previous editions obsolete. A fillable VA Form 10-0137 is available for download and filing through the link below. Alternatively, a printable version of the form can be found through the VA website.
This form has an equivalent in Spanish (Directrices Anticipadas De Va Poder Legal Para La Designacion De Agente Para El Cuidado De Salud Y Testamento En Vida) available through this link.
The form consists of five parts:
The completed copy of the VA Form 10-0137 should be presented in person or mailed to the individual's VA health care provider for medical records. Provide your health care agent with a copy, as well as and any person who is involved in the individual's healthcare decision. Keep the original of the completed form for your records.
VA 10-0137 Related Forms:
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