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Revocation of Health Care Proxy - New York 2026

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01. Edit your revocation health care proxy online
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Click ‘Get Form’ to open the Revocation of Health Care Proxy in the editor.
Begin by entering your name as the Declarant in the designated field. This identifies you as the individual revoking the proxy.
Next, fill in the date on which you executed your original Health Care Proxy. This provides context for your revocation.
In the section that states 'DATED this the', enter today's date to indicate when you are formally revoking the proxy.
Sign in the 'Signature of Declarant' field to authenticate your decision. Ensure that your signature matches any previous documents for consistency.
Print your name clearly in the 'Printed Name of Declarant' field to avoid any confusion regarding your identity.
Finally, provide your address in the 'Address of Declarant' section, ensuring all information is accurate and up-to-date.

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