Free New York Health Care Proxy

Table of Contents

1. Download a New York Health Care Proxy Sample
2. The Basics: What is a New York Health Care Proxy
3. Who Should Have a Health Care Proxy?
4. How to Select Your Agent
5. Decision Making Power of Your Agent
6. What if You Change Your Mind?
7. How to Complete Your Document

1. Download a New York Health Care Proxy Sample

Your Free New York Health Care Proxy Download

2. The Basics: What Is a New York Health Care Proxy Form?

In the state of New York, a health care proxy allows you to appoint a family member, a close friend, or some other trusted individual to make medical decisions if you’re no longer able to do so yourself. As your condition changes, this person can determine how your previously stated wishes apply to the situation at hand. Ultimately, your doctor and other healthcare providers must abide by your agent’s decisions as if you made those choices yourself.

As you proceed with your New York Health Care Proxy, you may encounter these terms as outlined in Section 2994-a of the Consolidated Laws of New York’s Public Health Law:

• Attending physician: The doctor who holds primary responsibility for your care.
• Health Care Agent: The person identified in your health care proxy, who will be responsible for making medical decisions when you no longer have the capacity to do so yourself.
• Life-sustaining treatment: Any treatment that is necessary to keep you alive.
• Decision-making capacity: Your ability to fully understand and appreciate the potential consequences of a given healthcare decision.
• Order not to resuscitate: This order prohibits cardiopulmonary resuscitation if you suffer cardiac or respiratory arrest.

For your reference, in New York a health care proxy can also be referred to as a:

• Health Care Power of Attorney
• Medical Power of Attorney

For non-medical issues, please refer to our Power of Attorney form.

3. Who Should Have a Health Care Proxy?

The need for a health care proxy is not determined by age or health status. This document is valuable to anybody who desires greater control over their medical future. However, it’s common to initiate a health care proxy when facing major life changes, such as:

• Marriage
• Divorce
• Having children
• Beginning a career in a high-risk industry
• Military deployment
• Acting as a caretaker for a loved one
• Diagnosis of a severe illness

4. How to Select Your Agent

The state of New York imposes the following restrictions, as defined by PHB § 2981, regarding the eligibility of health care agents:

• Your attending physician cannot act as both your agent and provide medical treatment. Therefore, if you appoint your attending physician as your agent, they’ll either need to decline the appointment or stop acting as your primary physician.
• You cannot elect an employee, operator, or administrator of a hospital, nursing home, or assisted living facility of which you are a patient or are currently residing.
• If your desired agent is presently appointed as a healthcare agent by ten other principals, they’re unable to act as your agent. This does not apply if the individual is your spouse, child, parent, brother, sister, or grandparent.

5. Decision Making Power of Your Agent

Your New York State Health Care Proxy can be as succinct or as detailed as you desire. In addition to highlighting an agent and an alternate, it may outline that person’s responsibilities or restrictions.

What Decision is Your Agent Able to Make?

According to Section 2982 of the New York Consolidated Laws’ Public Health Law, Unless otherwise stated, your agent has full control over all medical decision-making as soon as you become incapacitated. Examples of your agent’s powers and responsibilities include:

• Securing access to medical records — especially those necessary to make key healthcare decisions
• Approving the use of certain medications
• Consenting to or denying the administration of medical treatment if you have a terminal illness
• Consenting to or denying the use of life support if you fall into a coma

These and other decisions must be made within the scope of your wishes, including any reasonably known morals or religious beliefs and personal values.

What Decisions Is Your Agent Unable to Make?

Section 2981 of the New York Consolidated Laws’ Public Health Law states that, unless you have made your wishes regarding artificial hydration or nutrition (such as intravenous lines and feeding tubes) clear, your agent cannot consent to or refuse such measures. Your agent is also barred from making non-medical choices, such as financial decisions.

When is Your Agent Able to Begin Making Decisions?

According to Section 2983 of the New York Consolidated Laws’ Public Health Law, your agent can only begin making medical decisions on your behalf once your attending physician has determined that you lack capacity. .. Your attending physician is required to consult with another physician to confirm the determination and record it in your medical records. If lack of capacity is determined on the basis of mental illness, your attending physician must consult with a psychiatrist.

6. What if You Change Your Mind?

Your New York Health Care Proxy is valid indefinitely, unless you divorce or explicitly designate an expiration date. However, it is possible—and easy —to revoke your health care proxy.

How to Revoke a New York Health Care Proxy

According to Section 2985 of the New York Consolidated Laws’ Public Health Law, you can cancel your agent’s authority by notifying your agent or healthcare provider orally or in writing. Alternatively, your health care proxy can also be revoked by completing a subsequent document at a later date.

Your agent’s authority ends as soon as you recover capacity; however, that person may regain medical authority if you become incapacitated again at a later date.

Furthermore, if you suspect that you’ll eventually change your mind, you can indicate that your health care proxy will expire on a given date or under a specific set of circumstances.

In the event of divorce, you may not need to revoke your health care proxy. By law, your former spouse cannot act as your agent unless you explicitly state otherwise or create a new health care proxy.

7. How to Complete Your Document

In order to successfully complete your New York Health Care Proxy, you’ll need to authenticate your document and make sure it’s distributed to the appropriate parties.

Do You Need a Witness?

Section 2981 of the New York Consolidated Laws’ Public Health Law states that two adult witnesses must be present as you complete your health care proxy. Your agent cannot also act as your witness.

What Happens with the Signed Document?

Keep a copy of the completed and signed document for your personal records. Send additional copies to your agent and any alternate agents you may have designated.

Your New York Health Care Proxy allows you to express your medical priorities. This document is well worth the effort, as it can provide peace of mind for you and your loved ones.