Health Care Proxy - New York

New York · Fillable PDF · Free

Choose a health care agent to act when you cannot make your own medical decisions. New York does not allow a health care proxy to be combined with a power of attorney; financial authority uses a separate form. Appoint someone to make health care decisions.

Serving New York. New York appointments require New York-commissioned notaries.

Download Health Care Proxy - New York PDF · 4 pages. No account required.

Book a notary for Health Care Proxy - New York

Who this form is for

Appoint someone to make health care decisions.
Choose a health care agent to act when you cannot make your own medical decisions. New York does not allow a health care proxy to be combined with a power of attorney; financial authority uses a separate form.

What you'll need

The original Health Care Proxy packet and its instructions.
The names, dates and supporting records needed to appoint someone to make health care decisions.
The recipient's requirements and acceptable photo ID if arranging a notarial act.

How to complete it

Download the New York Health Care Proxy PDF and read its instruction page.
Enter the requested information to appoint someone to make health care decisions; confirm any choices you do not understand with a New York attorney.
Follow this packet's signature, witness and notarization directions. Do not pre-sign a statement that must be signed before the notary.
Save and print your completed copy, then follow the packet's delivery or recording instructions and keep a copy for your records.

Related New York forms

New York · Fillable PDF · 4 pages · Free

Appointment of Agent to Control Disposition of Remains - New York

Name the agent who will carry out your directions for burial, cremation or other disposition under the New York packet. Review successor agents, special directions and the witness requirements.

View Appointment of Agent to Control Disposition of Remains - New York · Download Appointment of Agent to Control Disposition of Remains - New York

New York · Fillable PDF · 3 pages · Free

HIPAA Authorization - New York

Identify who may disclose and receive your medical records, what information is covered and when permission ends. A HIPAA authorization releases information; it does not appoint a medical decision-maker.

View HIPAA Authorization - New York · Download HIPAA Authorization - New York

New York · Fillable PDF · 4 pages · Free

Living Will - New York

Put your treatment preferences in writing for situations covered by this New York living will. Discuss the instructions with your clinician and chosen health care agent; this is not a property-distribution will.

View Living Will - New York · Download Living Will - New York

New York · Fillable PDF · 3 pages · Free

Revocation of Health Care Proxy - New York

Document the New York health care proxy you are revoking. Follow the packet's notice instructions and inform the health care providers and agent who hold the earlier document.

View Revocation of Health Care Proxy - New York · Download Revocation of Health Care Proxy - New York

New York · Fillable PDF · 11 pages · Free

Statutory Short Form Power of Attorney - New York

Use New York's statutory short form to identify your agent and the financial powers you choose to grant. It does not authorize medical decisions; use a separate Health Care Proxy.

View Statutory Short Form Power of Attorney - New York · Download Statutory Short Form Power of Attorney - New York

These forms are a free convenience, not legal advice. First Choice Mobile Notary & Apostille is not a law firm. Consult an attorney licensed in the relevant state for legal questions.

Free legal forms by state · Book a mobile notary