Health care proxy: what it is and how to fill out the form
Reviewed in October 2026
A health care proxy is a form that names a person, called your agent, to make medical decisions when you cannot. New York and Massachusetts use the term in their laws. Other states call the same document a medical power of attorney.
What the health care proxy form asks
| Part of the form | What you write |
|---|---|
| Your name | The person giving the power |
| Your agent | Name, address and phone of the person you trust |
| Alternate agent | A backup if the first cannot act |
| Duration | Leave blank for no end date, or write a date or event |
| Limits or wishes | Treatments you want or refuse, including artificial nutrition |
| Organ donation | Optional, in some state forms |
| Signature and date | Yours, or someone signing at your direction |
| Witnesses | Two adults who saw you sign |
Health care proxy in New York
New York uses a short form from the Department of Health. You sign it in front of two adult witnesses. The person you name as agent cannot be one of them.
New York asks you to state your wishes about artificial nutrition and hydration clearly. Without that, the agent may not be able to decide on feeding tubes.
Health care proxy in Massachusetts
Massachusetts also uses a health care proxy with two adult witnesses. The agent cannot witness. The proxy takes effect when your doctor determines in writing that you lack capacity.
Other states
Most states call it a medical power of attorney or put it inside an advance directive. The idea is the same. Your state form tells you how many witnesses you need and whether a notary works instead.
Health care proxy and living will
A health care proxy names a person. A living will states your wishes in writing. They work best together.
No document can foresee every situation. A proxy gives a person you trust the power to decide on what the living will did not cover.
When the proxy is used
- 1You are in the hospital and cannot understand or communicate.
- 2Your doctor decides you lack capacity and writes it in your chart.
- 3Your agent receives the information you would receive.
- 4Your agent decides, following your wishes and your best interest.
- 5If you recover capacity, decisions go back to you.
Choosing your agent
Choose someone who knows your values and will speak up for them. It does not need to be the closest relative. It needs to be the person who will do what you asked.
Talk with them before you sign. Tell them what quality of life means to you, and which treatments you would want or refuse.
The first lines of a health care proxy
- 1Agent. I, [your name], hereby appoint [agent name, address and phone] as my health care agent to make any and all health care decisions for me, except to the extent I state otherwise.
- 2Effect. This proxy shall take effect only when and if I become unable to make my own health care decisions.
- 3Alternate. If the person I appoint is unable, unwilling or unavailable to act, I appoint [alternate name, address and phone].
- 4Duration. Unless I revoke it or state an end date or event, this proxy shall remain in effect indefinitely.
Use the medical power of attorney form or download your state form.
How to sign a health care proxy online
Upload a health care proxy to SignSolú or start from a template. Add each signer with a name and a phone number or email.
Each signer gets a link by WhatsApp or email. On a phone they tap the brown bar at the bottom that says «Sign as …».
They draw their signature once with a finger and press «Sign and Send». Every place in the document that needs it gets filled.
A line next to that button records their consent to sign electronically, with a link to the disclosure.
The signed PDF ends with an audit certificate. It shows each signer, the time, the IP address and a SHA-256 hash of the file.
If the other side sends their own PDF form instead, fill in the PDF form online, add the date and your signature, and download it.
Health care proxies are signed in front of witnesses. Some states accept electronic signatures and remote witnessing for these forms, others still ask for ink. Check your state rules before you sign.
Where to keep it
- Give the original or a copy to your agent and your alternate.
- Ask your doctor to put a copy in your medical record.
- Keep a copy where your family can find it, not in a safe deposit box.
- Take a copy to any hospital stay.
Common mistakes
- 1Leaving the wishes section blank. Your agent may not be able to decide on feeding tubes.
- 2Using the agent as a witness. The form can be invalid.
- 3Not telling the alternate. They learn they are in charge in an emergency room.
- 4Locking the form away. Nobody can reach a safe deposit box on a Sunday night.
- 5Never updating it. After a divorce, the former spouse may still be named.
An example
Linda lives in New York. She fills in the state health care proxy, names her best friend as agent and her niece as alternate. Two neighbors sign as witnesses.
She writes that her agent knows her wishes about artificial nutrition. When Linda is hospitalized after an accident, her friend shows the proxy and decides with the doctors. Her niece is ready in case she is needed.
Health care proxy for a young adult
At 18, a child becomes an adult in the eyes of the hospital. Parents lose the automatic right to decide or even to see records.
Many families have a college student sign a health care proxy and a HIPAA release before leaving home. If something happens far away, a parent can talk to the doctors.
People also ask
Can I make a health care proxy without a lawyer?
Yes. State forms are written for people to fill in on their own. Read each section, write your wishes in plain words and follow the witness rules printed on the form.
What should I tell my health care agent?
Tell them what a good day looks like for you, which treatments you would refuse, where you want to be cared for and who else they should keep informed. Write the key points on the form.
Does a health care proxy work in an emergency room?
Yes, once a doctor finds you cannot decide. Until then, the team asks you directly.
Can I name two people as my health care proxy?
Most forms name one agent and one alternate. Two agents acting together can slow decisions in an emergency, so most people pick one person and a backup who steps in only if needed.
Does a health care proxy cover mental health care?
It can. Some states have a separate psychiatric advance directive. If mental health treatment matters to you, write your wishes in the proxy or in that separate form.
Can I write my wishes in my own words?
Yes. The form has space for instructions and limits. Short, clear sentences about what matters to you help your agent more than long legal language.
Who keeps the original health care proxy?
You do, or your agent. Hospitals accept copies in most cases. Keep the original where your family can find it fast.
Who can be a health care proxy?
Any adult you trust, usually a spouse, partner, adult child or close friend. Some states exclude your own doctor or care facility staff.
What is the difference between a health care proxy and a power of attorney?
A health care proxy covers medical decisions only. A financial power of attorney covers money and property.
Does a health care proxy expire?
No, unless you write an end date or event. It stays valid until you revoke it.
Do hospitals keep a health care proxy on file?
Many do. Ask your doctor to scan it into your record and bring a copy to any admission.
Forms to use now
Sources
- Legal Information Institute, Cornell Law School, «power of attorney»
- ESIGN Act, 15 U.S.C. 7001, on govinfo.gov
Frequently asked questions
Is a health care proxy the same as a medical power of attorney?
Yes, in practice. The name changes by state.
Does a health care proxy need a notary?
Not in New York or Massachusetts. Two adult witnesses are enough there.
Can my agent be a witness?
No. The agent cannot witness the proxy that names them.
Can I revoke my health care proxy?
Yes. Tell your agent or doctor, or sign a new proxy.
What happens without a health care proxy?
Doctors turn to family under the order your state sets. A court may decide if they disagree.
Does my agent pay my medical bills?
No. A health care agent makes care decisions, not payments.
Should my 18-year-old sign a health care proxy?
Many families do. At 18, parents no longer decide or see records by default.
Is a health care proxy valid in another state?
Often yes. Many states honor proxies valid where they were signed.