Health Care Proxy

Appointing Your Health Care Agent in New York State
The New York Health Care Proxy Law allows you to appoint someone you trust, like a family
member or close friend, to make health care decisions for you if you lose the ability to make
them yourself. By appointing a health care agent, you can make sure that health care providers
follow your wishes. Your agent can also decide how your wishes apply as your medical
condition changes. Hospitals, doctors and other health care providers must follow your agent’s
decisions as if they were your own. You may give the person you select as your health care
agent as little or as much authority as you want. You may allow your agent to make all health
care decisions or only certain ones. You may also give your agent instructions that he or
she must follow. The Health Care Proxy Form can also be used to document your wishes or
instructions with regard to organ and/or tissue donation.

About the Health Care Proxy Form
It is an important legal document. Before signing, you should understand the following facts:
• The form gives the person you choose as your agent the authority to make all health care
decisions for you, including the decision to remove or provide life-sustaining treatment,
unless you say otherwise in the form. “Health care” means any treatment, service or
procedure to diagnose or treat your physical or mental condition.
• Unless your agent reasonably knows your wishes about artificial nutrition and hydration
(nourishment and water provided by a feeding tube or intravenous line), they will not be
allowed to refuse or consent to those measures for you.
• Your agent will start making decisions for you when your doctor determines that you are
not able to make health care decisions for yourself.
• You may write on the form examples of the types of treatments you would not desire
and/or those treatments you want to make sure you receive. The instructions may be
used to limit the decision-making power of the agent. Your agent must follow your
instructions when making decisions for you.
• You do not need a lawyer to fill out the form.
• You may choose any adult (18 years of age or older), including a family member or close
friend, to be your agent. If you select a doctor as your agent, they will have to choose
between acting as your agent or as your attending doctor because a doctor cannot do
both at the same time. Also, if you are a patient or resident of a hospital, nursing home or
mental hygiene facility, there are special restrictions about naming someone who works
for that facility as your agent. Ask staff at the facility to explain those restrictions.
• Before appointing someone as your health care agent, have a discussion first to make
sure that they are willing to act as your agent. Tell them that they will be your health care
agent. Discuss your health care wishes and the form with your
agent. Be sure to give them a signed copy. Your
agent cannot be sued for health care decisions
made in good faith.
• If you have named your spouse as your
health care agent, but later divorced or legally
separated, your former spouse can no longer be
your agent by law, unless you state otherwise.
If you would like your former spouse to remain
your agent, you may note this on your current
form and date it, or complete a new form
naming your former spouse.
• Even though you have signed the form, you
have the right to make health care decisions for
yourself as long as you are able to do so, and
treatment cannot be given to you or stopped if
you object, nor will your agent have any power
to object.
• You may cancel the authority given to your agent
by telling them or your health care provider
orally or in writing.
• Appointing a health care agent is voluntary. No one can require you to appoint one.
• You may express your wishes or instructions regarding organ and/or tissue donation
on the form.
Having a signed health care proxy form is the best way to ensure that health care is
provided according to the patient’s wishes.

MJHS Heath System Caregiver Happily with Senior Resident Next to a Pot of Tea

MJHS Home Care is always personalized care.

One of the benefits of being part of the MJHS Health System is that we have different care options available to you, depending on your individual needs. If you need short-term home care after surgery to help manage conditions such as heart failure or COPD, or if you are experiencing pain and suffering due to an advanced illness, MJHS Home Care may be an option for you. If you require ongoing care at home and qualify for Medicaid, HomeFirst, our managed long-term care plan, can provide care and assistance coordinating health and long-term care services.

Explore Both Options