New Hampshire Healthcare Power of Attorney and Advance Directive

The day your child turns eighteen in New Hampshire, hospitals stop treating you as the decision-maker by default. They generally need the young adult's authorization to share test results, discuss treatment plans, or obtain consent to procedures — because your child is now a legal adult and HIPAA protects their medical privacy. A HIPAA release can authorize information sharing, while a healthcare advance directive under RSA 137-J can designate an agent to make decisions when the young adult lacks capacity.

New Hampshire's advance directive combines two documents into one: a healthcare proxy (designating an agent to make medical decisions) and a living will (stating treatment preferences for end-of-life situations). For transition-age young adults with disabilities, the healthcare proxy component is the critical piece.

How the Proxy Works

The healthcare agent's authority is dormant by default. As long as your child can understand and communicate their own healthcare preferences, they make their own decisions. The agent's power activates only when a licensed physician or treating clinician determines that the person lacks clinical capacity for a specific medical decision.

This is a meaningful safeguard. An advance directive doesn't hand over permanent control of someone's medical care. It creates a safety net for situations where the person genuinely cannot participate in the decision — an emergency, a complex surgical consent, or a period of acute incapacity.

Execution Requirements Under RSA 137-J

For the advance directive to be legally valid, it must be:

1. Signed by the principal (the young adult)
2. Acknowledged before a notary public or signed in the presence of two adult witnesses

If using witnesses instead of a notary, neither witness can be:

• The named healthcare agent
• An alternate agent
• An employee of any healthcare provider currently treating the principal

The principal must have sufficient capacity to understand and appreciate generally the benefits, harms, and reasonable alternatives to proposed healthcare. A diagnosis of intellectual disability or autism does not automatically disqualify someone from executing this document. The question is whether they understand the healthcare choices and the delegation of authority.

Advance Directive vs. HIPAA Release

These serve different purposes and many families need both:

HIPAA release: Authorizes healthcare providers to share your child's medical information with you. It does not give you any decision-making authority. It's a permission slip for information access, nothing more.

Advance directive: Authorizes your healthcare agent to make actual medical decisions — consent to surgery, choose between treatment options, accept or refuse care — when the principal lacks capacity.

A young adult who wants their parent involved in healthcare might sign both: a HIPAA release so the parent can access records and communicate with doctors during routine care, and an advance directive so the parent can make decisions during a genuine medical crisis.

When an Advance Directive Isn't Enough

The advance directive covers medical decisions only. It doesn't help with:

• Financial management: You need a durable power of attorney under RSA 564-E for bank accounts, bill payments, and benefit applications
• Educational decisions: An educational representative delegation under Ed 1120.01 handles IEP rights
• Daily living support: A Supported Decision-Making agreement under RSA 464-D covers help with non-medical decisions
• Government benefits: A representative payee designation with the SSA manages SSI and Social Security funds

For families where the young adult's needs span multiple domains, an advance directive is one piece of a larger legal planning package. The question is whether voluntary documents can cover all the gaps, or whether some domains require guardianship.

Timing It Right

The advance directive can't be signed until the young adult turns eighteen. But it should be drafted and ready for execution in the weeks leading up to the birthday. If a medical situation arises between the eighteenth birthday and the date the directive is signed, you'll have no legal authority to participate in healthcare decisions.

For families coordinating the advance directive with SDM agreements, powers of attorney, and potential guardianship filings, the New Hampshire Adult Guardianship & Alternatives Guide includes an execution checklist with witness requirements and timing guidelines for each document.

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