Printable Health Care Proxy Form

When Would My Health Care Agent Begin To.

Once you complete a health care proxy, hospitals, doctors and other health care providers must follow your agent’s decisions as if they are your own. You must date and sign this health care proxy form. The partnership grants permission to reproduce this document in its entirety, so long as the source, including this statement, is shown. Attached is a health care proxy form that you can complete for your records.

You Can Either Tell Your Agent What Your Wishes Are Or.

You can use the form printed here, but you don’t have to use this form. Help your patients create a legally binding document with our free health care proxy form. View, download and print health care proxy pdf template or form online. Examples of medical treatments about which you may wish to give your agent special instructions are listed below.

Your Agent Cannot Sign As A Witness.

Be sure to include your address. This is not a complete list: You don’t need a lawyer or a notary, just two adult witnesses. This health care proxy form was prepared by the central massachusetts partnership to improve care at the end of life.

12 Health Care Proxy Form Templates Are Collected For Any Of Your Needs.

Download a free pdf template and example here. All competent adults, 18 years of age or older, can appoint a health care agent by signing a form called a health care proxy. If you are unable to sign yourself, you may direct someone else to sign in your presence. In order for your agent to make health care decisions for you about artificial nutrition and hydration (nourishment and water provided by feeding tube and intravenous line), your agent must reasonably know your wishes.