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Health Care Proxy Health Care Decisions Statutory Form including Living Will Provisions - New York 2025

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The document is a Health Care Proxy form under New York Public Health Law, allowing an individual (the principal) to appoint a health care agent to make medical decisions on their behalf if they become unable to do so. It includes provisions for stating specific wishes or limitations regarding health care decisions, the appointment of an alternate agent, and details about the proxy's duration. The document requires signatures from the principal and witnesses to validate its execution.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name as the principal at the top of the form. This identifies you as the individual granting authority.
Next, appoint your health care agent by filling in their name, home address, and telephone number. This person will make health care decisions on your behalf if you are unable to do so.
Consider stating any specific instructions or wishes regarding your health care decisions in the designated section. This can include preferences about artificial nutrition and hydration.
If necessary, appoint an alternate agent by providing their name, address, and phone number in case your primary agent is unavailable.
Specify a date or condition for when this proxy should expire if you do not want it to remain in effect indefinitely.
Sign and date the document at the bottom. Ensure that witnesses sign as well, confirming they are not appointed agents.

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What is the difference between a health care proxy and a living will in NY?

In order for the health care proxy to become effective, two doctors must decide that you are not able to make your own decisions. Living will allows you to leave written instructions that explain your health care wishes, especially about end-of-life care.

What is the main disadvantage of a living will?

Upon admission, a nurse must assess for a living will, document it, communicate the patients wishes to the healthcare team, respect those wishes in care, and encourage updates of the living will as needed. These steps are crucial for ensuring that the patients preferences regarding treatment are honored.

What is the NYS law regarding health care proxies?

The Health Care Proxy Law lets you voluntarily appoint a competent adult to make decisions about your medical treatment in the event you lose the ability to decide for yourself including decisions to remove or provide life-sustaining treatment.

Does a living will supersede a healthcare proxy?

Can a healthcare proxy override a living will? A Health Care Proxy cannot override any provisions made in a Living Will. A Living Will is legally-binding and must be followed. Therefore, it is helpful to both the Proxy and the medical care team if the Living Will is detailed and specific as possible.

Is a living will the same as a healthcare POA?

Health care power of attorney Unlike a living will, it applies to both end-of-life treatment as well as other areas of medical care. However, like a living will, the proxy only has power to act on your behalf when you are unable to do so yourself, whether from loss of consciousness or mental ability.

nys health care proxy form

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How to get a health care proxy in NY?

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 dont 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 dont have to use this form.