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Health Care Proxy


A health care proxy is an important document for every adult to complete and keep on file. The proxy enables your family members and medical professionals to carry out your wishes in the event you become unable to make your own decisions.

Here you can download a blank copy of a health care proxy form distributed by the New York State Department of Health. You'll need Adobe Acrobat Reader to view and print the form. Then fill out the information, have a witness sign it and keep a copy. Give a copy to your designated health care agent and, if you selected one, your alternate agent. Keep another copy for yourself with your important records.

Taking the time to complete this document will take the burden of difficult decision-making away from your loved ones and give them peace of mind.

Health Care Proxy Form