Health Care Proxy Form - New York
Frequently Asked Questions
Why should I choose a health care agent?
If you become unable, even temporarily, to make
health care decisions, someone else must decide
for you. Health care providers often look to family
members for guidance. Family members may
express what they think your wishes are related to
a particular treatment. Appointing an agent lets
you control your medical treatment by:
•allowing your agent to make health care
decisions on your behalf as you would want
•choosing one person to make health care
decisions because you think that person would
make the best decisions;
•choosing one person to avoid conict or
confusion among family members and/or
You may also appoint an alternate agent to take
over if your ﬁrst choice cannot make decisions
Who can be a health care agent?
Anyone 18 years of age or older can be a health
care agent. The person you are appointing as your
agent or your alternate agent cannot sign as a
witness on your Health Care Proxy form.
How do I appoint a health care agent?
All competent adults, 18 years of age or older,
can appoint a health care agent by signing a form
called a Health Care Proxy. You don’t need a lawyer
or a notary, just two adult witnesses. Your agent
cannot sign as a witness. You can use the form
printed here, but you don’t have to use this form.
When would my health care agent begin to
make health care decisions for me?
Your health care agent would begin to make
health care decisions after your doctor decides that
you are not able to make your own health care
decisions. As long as you are able to make health
care decisions for yourself, you will have the right
to do so.
What decisions can my health care
Unless you limit your health care agent’s authority,
your agent will be able to make any health care
decision that you could have made if you were
able to decide for yourself. Your agent can agree
that you should receive treatment, choose among
different treatments and decide that treatments
should not be provided, in accordance with your
wishes and interests. However, your agent can
only make decisions about artiﬁcial nutrition
and hydration (nourishment and water provided
by feeding tube or intravenous line) if he or she
knows your wishes from what you have said or
what you have written. The Health Care Proxy
form does not give your agent the power to make
non-health care decisions for you, such as
Why do I need to appoint a health care agent
if I’m young and healthy?
Appointing a health care agent is a good idea
even though you are not elderly or terminally ill.
A health care agent can act on your behalf if you
become even temporarily unable to make your
own health care decisions (such as might occur if
you are under general anesthesia or have become
comatose because of an accident). When you
again become able to make your own health care
decisions, your health care agent will no longer be
authorized to act.
How will my health care agent
Your agent must follow your wishes, as well as
your moral and religious beliefs. You may write
instructions on your Health Care Proxy form or
simply discuss them with your agent.
How will my health care agent know
Having an open and frank discussion about your
wishes with your health care agent will put him or
her in a better position to serve your interests. If
your agent does not know your wishes or beliefs,
your agent is legally required to act in your best
interest. Because this is a major responsibility for
the person you appoint as your health care
Health Care Proxy Form - New York PDF
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