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  1. 15 Ιουλ 2024 · Help your patients create a legally binding document with our free Health Care Proxy Form. Download a free PDF template and example here.

  2. In Massachusetts, if you are at least 18 years old and competent, you may complete a Health Care Proxy form, selecting another person (called your Health Care Agent) to make health care decisions for you if you cannot make such decisions yourself.

  3. Health Care Proxy Form Instructions Item (1): Write the name, home address and telephone number of the person you are selecting as your agent. Item (2): If you want to appoint an alternate agent, write the name, home address and telephone number of the person you are

  4. A health care proxy is a document in which you name a health care agent – someone you designate to speak for you regarding your health care if your doctor determines you are not able to make or to communicate your own health care decisions.

  5. Health Care Proxy. A completed health care proxy is a legal document that allows you to name a trusted family or friend as your agent to make medical decisions in the event that you are unable to do so. We recommend that you download and print out the New York Health Care Proxy form before your stay at Strong Memorial Hospital.

  6. 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.

  7. Health Care Proxy Form Instructions Item (1) Write the name, home address and telephone number of the person you are selecting as your agent. Item (2) If you want to appoint an alternate agent, write the name, home address and telephone number of the person you are selecting as your alternate agent. Item (3) Your Health Care Proxy will remain valid

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