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Home Personal & Family Documents Power of Attorney Medical New York

New York Health Care Proxy Form

Use our New York Health Care Proxy form to let someone make medical decisions for you if you become unable to do so.

Updated April 13, 2022 | Legally reviewed by Susan Chai, Esq.

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 communicate responsibly.

Laws: Article 29-C of the Consolidated Laws of New York’s Public Health Law (PBH §2980-2994) governs health care proxies in New York.

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.
  • NY 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

Ensure your form adheres to the regulations outlined in PBH §2980-2994 by following the steps below.

Download a Health Care Proxy Form

Download the blank template for New York below and start creating your own.

Download: PDF | Word

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 communicate your wishes responsibly.

Who should you choose as an agent?

Your agent should be an adult you trust to make crucial 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 explicitly described in your Proxy form.

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: PBH § 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 cannot make a timely decision about your health care.

Relevant law: PBH § 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 Health Care Proxy form.

Can you limit your agent’s powers?

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 decides 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: PBH § 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 decide for you that goes against your values, isn’t in your best interest, or is unrelated to your health care.

Relevant law: PBH § 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 cannot 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: PBH § 2983

Step 3: Sign the form

Do you need a 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 cannot sign.

Relevant law: PBH § 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 PBH § 2981 if applicable to your situation.

Relevant law: PBH § 2981

How long is your Health Care Proxy effective in New York?

You can include a date or condition upon which your Health Care Proxy will expire if you wish. Otherwise, it will be effective indefinitely.

Relevant law: PBH § 2981

How to Revoke a New York Health Care Proxy

You can revoke your Health Care Proxy 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 form with different terms
  • Sign a Revocation of Power of Attorney form and share a copy with your doctor or agent

If you choose your spouse as your agent, legally separating or getting a divorce will revoke your proxy.

Relevant law: PBH § 2985

Related Will & Estate Planning Documents

  • New York Durable Power of Attorney: Our free NY durable power of attorney form lets an agent act on your behalf in certain affairs even if you become incapacitated.
  • New York Power of Attorney: A New York Power of Attorney is a written document that officially recognizes a legally binding relationship between two parties -- a Principal and an Agent....
  • DNR Form: States that you refuse resuscitation via CPR in the event that your heart stops beating or you stop breathing.
New York health care proxy (medical power of attorney)

Free New York Health Care Proxy Form

Create Your New York Health Care Proxy in Minutes!

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