Name: Fillable Form New York Health Care Proxy | PDFRun
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What is the New York Health Care Proxy Form?

The New York Health Care Proxy Form is a legal document allowing an individual called the principal to choose a trusted person as their agent. The agent is given the authority to make all healthcare decisions for the principal, such as the decision to remove or provide life-sustaining treatment.

The NY Health Care Proxy Form shall be used when you become unable to make healthcare decisions. Health care providers rely on your family members for guidance when it comes to crucial decisions, such as your health. When you appoint an agent, you let them control your medical treatment by:

Allowing them to make healthcare decisions on your behalf;
Choosing one person to make healthcare decision as you think that person would make the best decisions; and
Choosing a person to avoid conflict or confusion between your family members or significant others.

This form allows you to appoint another agent if your first choice is unable to make decisions for you.

A health care agent must be someone who is at least 18 years old and is a competent adult. However, the person you appointed as your agent cannot sign as a witness on the Health Care Proxy Form in New York. You don’t need a lawyer or a notary when filling out this form – two adult witnesses are already enough to make this form binding.

You may need an agent if any of the following situations arise:

You are in a state of comatose from an accident or illness;
You are terminally ill and not expected to recover;
You are diagnosed with Alzheimer’s disease or other forms of dementia;
You are under general anesthesia;
You are in a vegetative state persistently; or
You are suffering from an illness in which you cannot communicate properly.

Your doctor may also decide to let your healthcare agent make healthcare decisions when they see that you are not able to make your healthcare decisions for yourself anymore.

In making the New York Health Care Proxy Form, you must clarify your beliefs and values. Write every medical wish that would reflect your values and priorities on this form. State the treatments you are willing to accept and determine the treatments you don’t want to receive.

Another thing you have to bear in mind when making this form is to have an honest conversation with your family members and close friends about what you want. While having this conversation, assess who will most likely represent your medical wishes. Once you determined your agent, continue to express your thoughts, opinions, and wishes to them. Not everything will go as planned, explaining your views to your agent allows them to make decisions on your behalf.

Lastly, share your thoughts and opinions with your health care providers. Expressing these to them will give them an idea of how to care for you consistently. You must also let them know that you have a New York State Health Care Proxy Form.

You may download a PDF copy of the New York Health Care Proxy Template from websites that offer such document templates. But you may electronically fill it out on PDFRun for your convenience.

How to fill out the New York Health Care Proxy Form?

Enter all necessary information in the required fields of the New York Health Care Proxy Form PDF. Make sure that everything you enter is true, accurate, and correct.

Name of Principal

Enter your full legal name.

Name of Health Care Agent

Enter the name of your health care agent.

This section states that the Health Care Proxy Form in New York shall take effect in the event the principal becomes unable to make their own health care decisions.

The principal directs their agent to make healthcare decisions in accordance with their wishes and instructions as stated above or as otherwise known to him or her. The principal also directs their agent to abide by any limitations on their authority as stated above or as otherwise known to him or her.

If the agent appointed above is unable, unwilling, or unavailable to act as the principal’s health care agent, the principal may appoint another person as their health care agent.

Name of Health Care Agent

Enter the name of the health care agent if the person appointed above is unable, unwilling, or unavailable to act as your health care agent.

The principal understands that, unless they revoke it, this proxy will remain in effect indefinitely or until the date of occurrence of the condition indicated below.

Take note the complete the following fields below if you do not want this health care proxy to be in effect indefinitely.

Expiration Date

Enter the expiration date of the proxy.

Signature

Affix your signature.

Address

Enter your complete address.

Date

Enter the date.

This section states that the principal declares that the person who signed or asked another to sign the New York State Health Care Proxy Form is personally known to them and appears to be of sound mind and acting willingly and free from duress. The principal signed this document in their presence and that the person signed in their presence. The witness is not the person appointed as an agent by this document.

Witness # 1’s Signature

Have witness # 1 affix their signature.

Name

Enter witness # 1’s full legal name.

Witness # 1’s Address

Enter witness # 1’s complete address.

Witness # 2’s Signature

Have witness # 2 affix their signature.

Name

Enter witness # 2’s full legal name.

Witness # 2’s Address

Enter witness # 2’s complete address.

Frequently Asked Questions About the New York Health Care Proxy Form

How to file the New York Health Care Proxy Form?

After signing the New York State Health Care Proxy Form, provide copies to your agent, doctor, attorney, and other family members or close friends. You must also keep a copy or store it in a place where no one has access to it, such as a safe deposit box.

Bring this form if you are admitted to the hospital when you will undergo a minor surgery or an outpatient surgery.

Does a healthcare proxy need to be notarized in New York?

There is no requirement that a healthcare proxy is notarized in New York. However, it is generally recommended that you have your proxy witnessed by two individuals who are not related to you and who are at least 18 years old. Additionally, you may want to consider having your proxy notarized in order to avoid any potential challenges to its validity.

Nevertheless, it is ultimately up to you whether or not to have your proxy notarized. A notarized healthcare proxy will generally be given more weight in court if there is ever a dispute about its validity, but even an un-notarized proxy can be upheld by a court if it is determined to be valid under New York law.

When your healthcare proxy is complete, you should give copies to your agent, your alternate agent, your physician, and anyone else who may need it in the event that you are unable to make decisions about your own healthcare. You should also keep a copy in a safe and easily-accessible place.

If you have any further questions about healthcare proxies or notarization requirements in New York, you should speak with an experienced healthcare attorney for guidance.

Can you have 2 healthcare proxies in NY?

According to New York State law, you can have more than one healthcare proxy, as long as each proxy is willing and able to serve in that role. If you have more than one healthcare proxy, you should designate which proxy will have primary authority to make healthcare decisions on your behalf. If you do not designate a primary healthcare proxy, then all of your proxies will have equal authority to make decisions on your behalf.

You should also indicate how you want your proxies to interact with each other. For example, whether you want them to consult with each other before making any decisions, or whether you want them to make decisions independently.

It is important to communicate your wishes to your proxies so that they can act according to your preferences. You should also keep your healthcare proxies up to date, in case your preferences change or one of your proxies is no longer able to serve.

Who can witness a health care proxy in NY?

In New York, a witness to a health care proxy should meet the following requirements:

Must be at least 18 years old
Cannot be the patient's health care agent
Cannot be related to the patient by blood, marriage, or adoption
Cannot be employed at the same facility where the patient is receiving care unless they are a member of the clergy or a social worker
Cannot have any financial interest in the patient's estate

If you are unable to find someone who meets all of the above requirements, you may be able to designate two "disinterested adults" as witnesses. These witnesses must:

Not be related to the patient by blood, marriage, or adoption
Not have any financial interest in the patient's estate
Not be employed at the same facility where the patient is receiving care

If you have any questions about who can serve as a witness to a health care proxy in New York, you should contact an experienced estate planning attorney for guidance.

What does a Health Care Proxy include?

A health care proxy should include the following:

The name and contact information of the person you are appointing as your health care proxy
Your instructions for your health care proxy, including what kinds of medical decisions you want them to be able to make on your behalf
A statement that your health care proxy will be able to make decisions on your behalf even if you are unable to communicate your wishes yourself.
Your signature and the signatures of two witnesses

When it comes to writing your instructions for your health care proxy, it is important to be as specific as possible. You should consider what kinds of medical decisions you would want your proxy to be able to make on your behalf, and how you would want them to make those decisions. For example, you may want to give your proxy authority to make decisions about life-sustaining treatment, or you may want them to make all medical decisions on your behalf. It is also important to think about what kind of guidance you would want your proxy to have in making those decisions. For example, you may want them to make decisions based on what they believe would be in your best interests, or you may want them to follow specific instructions that you provide.

Once you have decided what you want to include in your health care proxy, it is important to put it in writing. This will ensure that your wishes are clear and that your proxy knows exactly what they are supposed to do. It is also a good idea to have your proxy sign the document so that they can show that they understand and agree to their role. Finally, you should have two witnesses sign the document as well. This will help to ensure that the proxy is legally binding.

Is your spouse automatically your Health Care Proxy?

When there is no designated health care proxy, a spouse is usually the first in line to make decisions about medical treatment. However, this is not always the case. If you have concerns about your spouse making medical decisions on your behalf, it's important to have a conversation about your wishes and designate a health care proxy who you trust to make decisions in accordance with your wishes.

In cases where a person is unable to communicate their wishes, it may be up to the health care proxy to make decisions about what course of treatment to pursue. This can be a difficult task and one that you should discuss with your spouse ahead of time. You should also consider appointing an alternate health care proxy in case your spouse is unavailable or unable to make decisions on your behalf.

How do I set up a Health Care Proxy?

You can appoint a healthcare proxy by completing and signing a healthcare proxy form. You can get this form from your doctor, hospital, or state health department. Then, follow these steps:

Choose someone you trust to be your health care proxy. This person will make decisions about your medical care if you can't make them yourself.
Fill out the form and sign it in front of a witness.
Give a copy of the signed form to your proxy and to your doctor.

You can change or revoke your health care proxy at any time by completing and signing a new form.

What is the difference between a living will and a Health Care Proxy?

A living will and health care proxy are two different ways to plan for your medical care in the event that you are unable to make decisions for yourself. A living will is a legal document that sets forth your wishes regarding life-sustaining treatment, such as artificial ventilation or feeding tubes, in the event that you are unable to communicate your preferences. A health care proxy is a legal document that designates someone else to make decisions on your behalf about your medical care, in accordance with your wishes as expressed in the document.

These documents are typically used in conjunction with each other to ensure that your wishes about medical care are carried out, even if you are unable to communicate them yourself. It is important to discuss your wishes with both your health care proxy and your living will so that they are aware of your preferences and can make decisions accordingly.

Does a proxy need to be notarized?

There is no legal requirement that a health care proxy be notarized. However, some hospitals or other health care providers may require that a proxy be notarized in order to be considered valid. Additionally, notarizing a health care proxy can provide an extra level of assurance that the document is authentic and has been executed properly. If you have any questions about whether or not your health care proxy needs to be notarized, you should consult with an attorney or your healthcare provider.

Who makes medical decisions if you are incapacitated in NY?

If you are incapacitated, a medical decision maker will be appointed to make decisions on your behalf. The person appointed will be determined by the court. If you have a living will or health care proxy, the person you designate will be your medical decision maker. Otherwise, the court will appoint a close relative or friend to make decisions for you. The court will also appoint a guardian if one is needed.

Who makes medical decisions if there is no power of attorney in NY?

If someone becomes incapacitated and there is no power of attorney in place, medical decisions will have to be made by the person's family or close friends. If there is no one who is willing or able to make these decisions, a court may appoint a guardian to make them on the person's behalf.

Is a living will legal in NY?

A living will is a legal document that allows you to spell out your medical treatment preferences in advance. In New York, a living will be signed and dated by you and witnessed by two people who are not related to you or financially responsible for your care. Once it’s been properly executed, your living will become a binding directive that your health care providers must follow.

If you become incapacitated and cannot communicate your wishes, a living will ensures that your instructions regarding life-sustaining medical treatments are carried out. For example, if you’re in a vegetative state with no hope of recovery, a living will instructs your doctors to withhold lifesaving measures such as artificial nutrition and hydration.

A living will is different from a health care proxy, which appoints someone else to make medical decisions on your behalf. You can name a health care proxy in your living will, or you can execute a separate health care proxy form.

It’s important to note that a living will only takes effect if you are unable to communicate your wishes about medical treatment. If you’re able to express your preferences, your doctors must follow them.

If you want to create a living will in New York, you can use an online template or form provided by the state. You can also draft your own living will, but it’s advisable to have it reviewed by an attorney to make sure it meets all the legal requirements.

Does next of kin override power of attorney?

No, next of kin does not override power of attorney. Power of attorney is a legal document that gives someone else the authority to make decisions on your behalf. Next of kin is simply the person who is most closely related to you, typically your spouse or child. While your next of kin may be involved in some decision-making on your behalf, they do not have the same legal authority as someone with power of attorney.

Can a husband make medical decisions for his wife?

A husband may make medical decisions for his wife if she is unable to do so herself, but only if he has been specifically given this authority by her. If there is any disagreement between the husband and wife about what course of treatment should be followed, the final decision should be made by the wife's treating physician.

If the wife is incapacitated and unable to communicate her wishes, the husband may need to make decisions based on what he believes she would want. In some cases, this may mean making difficult decisions about life-sustaining treatment. Ultimately, the goal should be to act in the best interests of the wife, taking into account her values and preferences.

Should I have a healthcare proxy?

A healthcare proxy is someone you appoint to make medical decisions on your behalf if you are unable to do so yourself. This person can be a family member, friend, or anyone else you trust.

If you don't have a healthcare proxy and become incapacitated, your loved ones will have to make difficult decisions about your care without knowing your wishes. A healthcare proxy ensures that your voice is heard, even if you can't speak for yourself.

Making a healthcare proxy is a simple process. You'll need to fill out a form and name your proxy. You should also have a conversation with them about your wishes and expectations.

While having a healthcare proxy is not required, it is highly recommended. Everyone should have one in place, just in case.

Can a family member override power of attorney?

No, a family member cannot override power of attorney. Power of attorney is a legal document that gives someone else the authority to make decisions on your behalf. Once you have signed a power of attorney, you have given up your right to make decisions for yourself. Only the person named in the power of attorney can make decisions for you.

Can a notary notarize a will in NY?

A notary can notarize a will in New York State. For the will to be legal, it must be signed by two witnesses and the person making the will (the "testator"). The notary does not witness the signing of the will. Rather, the notary merely certifies that the signatures on the document are genuine.

How do I revoke a Health Care Proxy?

If you would like to revoke your Health Care Proxy, you can do so by completing and signing a revocation form. This form is typically available from the health care proxy agent or the person who assisted you in completing your original proxy form. Once the revocation form is signed, it should be delivered to your health care proxy agent, and copies should be given to your health care provider(s) and anyone else who might have a copy of your original proxy form.

Is your spouse automatically your Health Care Proxy in NY?

In general, without a healthcare proxy, your spouse would not automatically be your healthcare proxy in New York. You would need to specifically designate your spouse (or another individual) as your health care proxy in order for them to make medical decisions on your behalf in the event that you are unable to do so yourself.

When you are married, your spouse is usually the first person that you think of when designating a health care proxy. However, there may be circumstances where you would not want to designate your spouse as your health care proxy. For example, if you are estranged from your spouse or if you have children from a previous relationship, you may want to designate someone other than your spouse as your health care proxy.

It's important to think carefully about who you want to designate as your health care proxy. This person should be someone who you trust to make decisions in accordance with your wishes and who will act in your best interests.

In general, healthcare professionals recommend that you designate a family member or close friend as your healthcare proxy. You can also designate your spouse as your health care proxy, as long as you are comfortable with them making decisions on your behalf.

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