Power of Attorney form FAQ

How do I complete a Power of Attorney form for my student under 19?

  1. Download Nebraska Medicine – University Health Center’s Power of Attorney form and print it.
  2. Fill out the form as follows:
    1. First line: Parent/guardian’s name
    2. Second line: Parent/guardian’s city and state of residence
    3. Third line: Student’s name
    4. Fourth line: Student’s birth date and NUID number
    5. Check a box indicating whether the minor is 18 or under 18.
    6. On the last bullet point, the parent/guardian should write the day’s date and print his or her name. Do NOT sign until in the presence of a notary.
    7. The notary will fill out the bottom portion of the form and will then witness the parent/guardian sign.
  3. Send the completed, notarized form to the University Health Center
    1. Fax: 402.472.4593
    2. Mail: 1500 U Street, P.O. Box 880618, Lincoln, NE 68588-0618
POA Cheat Sheet

What is a notary?

A notary is a person authorized to perform certain legal formalities, especially to draw up or certify contracts, deeds and other documents for use in other jurisdictions. Among their many duties, notaries most often notarize signatures for documents requiring a notarial act. The signer must be physically present before a notary, prove his/her identity and acknowledge that he/she understands the document and is signing under his/her free will.

Where can I find a notary?

Oftentimes, notaries can be found at local banks, courthouses, UPS stores, some airports and—for international students—a local consulate.

What happens if I do not fill out a Power of Attorney form before my student seeks care at the University Health Center?

If a student under 19 seeks medical care at the University Health Center and does not have a Power of Attorney form on file, appointment desk staff in most situations must call parents/guardians at the time of check in to complete additional forms over the phone, which will delay patient care in non-emergent situations.

Should I keep a copy of the Power of Attorney form?

While this is optional, the University Health Center encourages parents/guardians to keep a copy of the Power of Attorney form for themselves as it can be used at other medical facilities in Nebraska.