in such an event, the agent selected will make health care decisions on their behalf and instruct medical staff to the patient’s wishes. this document must be issued by the private party who wishes to appoint a specific health care agent with the power to deliver or withhold consent regarding his or her medical treatment when incapacitated. the illinois health care agent that the principal wishes to name as the person to make medical decisions when incapacitated must be identified. this appointment template can be used to nominate the health care agent for this role (by checking the appropriate statement) or solidify that at the time of this document’s execution the principal doe not necessarily endorse the health care agent for the role of court-appointed guardian by leaving the checkbox statement unmarked. the authority to represent the principal’s medical preferences before illinois physicians will need an event to trigger the effect of this document (which is to grant such authority to the health care agent named above). only one of the effect statements may be initialed by the principal to apply this definition to the appointment.