Revocation of Health Care Proxy - Massachusetts 2026

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The document is a formal revocation of a previously executed Health Care Proxy by the Declarant, allowing them to withdraw their health care decisions and choices as designated in the original proxy. It outlines the legal basis for revocation under Massachusetts law and provides options for revoking specific parts of the proxy. The Declarant signs and dates the document to confirm the revocation.

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Click ‘Get Form’ to open it in the editor.
Begin by entering your name as the Declarant in the designated field at the top of the form.
Fill in the date you executed your original Health Care Proxy, including day and year.
Indicate whether you are revoking all parts of the Health Care Proxy or specific sections by checking the appropriate boxes provided.
If revoking specific parts, ensure to check each relevant section: Designation of Agent for Health Care, Instructions for Health Care, Anatomical Gifts at Death, and Primary Physician.
Complete the date on which you are signing this revocation form.
Sign your name in the Signature of Declarant field and print your name below it. Lastly, provide your address in the designated area.

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What is the healthcare proxy statute in Massachusetts?

What does the Health Care Proxy Law allow? The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.

Can you have more than one Health Care Proxy in Massachusetts?

May I have more than one person as my Proxy? In Massachusetts, you may name one primary Proxy and also an alternate Proxy. The alternate person would only step in as your Proxy if your primary Proxy was unavailable or was unable or unwilling to serve.

Who can revoke a healthcare proxy in Massachusetts?

A principal may revoke a health care proxy by notifying the agent or a health care provider orally or in writing or by any other act evidencing a specific intent to revoke the proxy.

What is revocation of proxy?

The Revocation of Proxy clause defines the process by which a person who has granted a proxytypically the authority to vote or act on their behalfcan withdraw or cancel that authorization.

Can a healthcare proxy be revoked?

The health care proxy becomes effective only when you become unable to make decisions, as determined by a physician. Until then, you continue to be in charge of making your own health care decisions. It can be revoked orally, and you always have the right while competent to sign a new health care proxy.

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What is the Health Care Proxy law in Massachusetts?

This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions.