A New York (NY) health care proxy is a document that lets you assign a trusted person as your health care agent. Your agent is responsible for making medical decisions on your behalf if your doctor decides you’re too sick to responsibly communicate.
A New York health care proxy can also be called a:
- New York State Health Care Power of Attorney
- Health Care Proxy Form NY
Laws: Article 29-C of the Consolidated Laws of New York’s Public Health Law (PHB §2980-2994) governs health care proxies in the state of New York.
Download a New York Health Care Proxy Form
Download: Word (.docx) or Adobe PDF
You never know when you might fall ill and need assistance managing your health care and daily affairs (like paying bills). In addition to your NY health care proxy, consider adding the following documents to account for your end of life planning so that medical and financial decisions can be made in the event of death or incapacitation:
- Living Will: This document lets you describe whether you’d want to receive specific medical treatments so your doctor knows how to proceed in an emergency.
- New York Power of Attorney: This type of power of attorney lets you pick an agent to handle your financial affairs to the extent you allow.
How to Fill in a Health Care Proxy Form in New York
Make sure your health care proxy adheres to the regulations outlined in PHB §2980-2994 by following the steps below.
Step 1: Choose an agent
Your health care agent will step in to make medical decisions on your behalf if you’re too sick to responsibly communicate your wishes.
Who should you choose as an agent?
Your agent should be an adult you trust to make important decisions relating to your health care should you become unable to communicate. Your agent should understand your values well enough to be able to make decisions (if necessary) about treatments not specifically described in your health care proxy.
Who can’t be your agent?
New York law restricts the following people from serving as your agent:
- The person administering your health care (like your doctor)
- Anyone who works for your hospital or care facility, unless they’re related to you
Additionally, you can’t choose someone who already serves as a health care agent for more than ten people, unless they’re your immediate family member, grandparent, or spouse.
Relevant law: PHB § 2981
Can you have more than one agent?
Yes, you may choose an alternate agent to take over if your doctor confirms in writing that your primary agent isn’t able to make a timely decision about your health care.
Relevant law: PHB § 2981
Step 2: Specify what healthcare decisions your agent can make
Consider if there are any decisions you wouldn’t want your agent to make on your behalf, and note your wishes in your NY health care proxy form.
Can you limit your agent’s powers?
Yes, you can include specific instructions about your healthcare or describe how you want to limit your agent’s powers in the document.
If you don’t limit your agent’s powers, they’ll be able to make any medical decision for you, such as:
- Mental health treatment
- Organ and tissue donation
- Life-sustaining treatment
When your health care agent makes a decision for you, New York law requires them to consult with medical professionals and make decisions based on your wishes. If your agent doesn’t know your values regarding a specific matter, they must act in your best interest.
Relevant law: PHB § 2982
What is your agent legally unable to do?
Unless they know whether you would want to receive artificial nutrition or hydration, your agent can’t decide to administer or withhold artificial nutrition/hydration.
Your agent also can’t make any decision for you that goes against your values, isn’t in your best interest, or is unrelated to your health care.
Relevant law: PHB § 2982
When can your agent start making decisions for you?
Your agent can only begin making medical decisions on your behalf once your doctor determines you lack the capacity to responsibly make healthcare decisions for yourself.
Once your doctor determines you’re incapacitated, they’re required to notify the following people:
- You (if you’re able to comprehend)
- Your agent
- The director of your mental health facility (if applicable)
- Your conservator or committee (if you have a court-assigned fiduciary due to incapacity)
Additionally, if the reason for your incapacity relates to your mental health or a developmental disability, your doctor is required to consult with a qualified specialist.
Relevant law: PHB § 2983
Step 3: Sign the form
Do you need witness or notary signatures?
Yes, two adult witnesses must be present when you sign your health care proxy. You can direct someone else to sign for you in your presence if you’re unable to sign.
Relevant law: PHB § 2981
Who can’t be a witness?
The person you select as your agent can’t act as a witness. New York state has additional witness requirements if you live in a mental health facility, so be sure to review PHB § 2981 if applicable to your situation.
Relevant law: PHB § 2981
How long is your New York health care proxy effective?
If you wish, you can include a date or condition upon which your health care proxy will expire. Otherwise, it will be effective indefinitely.
Relevant law: PHB § 2981
How to Revoke a New York Health Care Proxy
You can revoke your health care proxy at any time unless a court decides you’re too sick to make decisions for yourself. Use any of the following methods to revoke your proxy:
- Notify your agent or doctor that you want to revoke your proxy
- Create a new health care proxy with different terms
- Sign a revocation of power of attorney form and share a copy with your doctor or agent
Additionally, if you choose your spouse as your agent, legally separating or getting a divorce will revoke your proxy.
Relevant law: PHB § 2985
