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Free New York Medical Power of Attorney Form

A New York medical power of attorney is called a health care proxy, and it appoints a health care agent under Public Health Law Article 29-C. Fill in our guided form and sign it with two adult witnesses.

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What Is a Medical Power of Attorney in New York?

New York calls this a health care proxy. Under Public Health Law § 2981, a competent adult can use one to appoint a health care agent who makes decisions when the adult cannot.

New York Health Care Proxy Rules

Public Health Law § 2981 sets the requirements.

Everyone Is Presumed Competent

Every adult is presumed competent to appoint an agent. That changes only if a court has found the person not competent, or a guardian of the person has been appointed.

Two Adult Witnesses Sign

You sign and date the proxy in the presence of two adult witnesses, who also sign it. The witnesses state that you appeared to sign willingly and free from duress.

Someone Can Sign for You

If you cannot sign, another person may sign and date it for you. They do so at your direction and in your presence, with the two witnesses there.

Your Agent Cannot Witness

The person you appoint as your agent cannot act as a witness to your New York medical power of attorney.

Does a New York Medical Power of Attorney Need a Notary?

No. New York’s statute requires two adult witnesses and does not add a notary step. You can finish a New York medical power of attorney with just your signature, the date, and two qualified witnesses.

Some proposals in Albany would change the number of witnesses, but they are not law. Until they are, plan on two.

Extra Rules in Mental Hygiene Facilities

If you live in a facility operated or licensed by the Office of Mental Health, at least one witness must be unaffiliated with the facility. If that facility is also a hospital, at least one witness must be a qualified psychiatrist or psychiatric nurse practitioner.

How to Sign Your New York Medical Power of Attorney

Follow this order to complete your New York medical power of attorney form:

  1. Name your health care agent and an alternate.
  2. Add any limits or instructions for your agent.
  3. Choose two adults who are not your agent to serve as witnesses.
  4. Sign and date the proxy while both witnesses watch.
  5. Have each witness sign and state you appeared to act willingly.
  6. Give copies to your agent, your alternate, and your doctors.

What to Include in Your New York Form

A New York health care proxy usually includes:

  • Your health care agent and an alternate
  • Any limits on the decisions your agent can make
  • Any instructions about specific treatments
  • Your signature, the date, and both witnesses’ signatures and statements

Choose an agent who knows your values and is willing to speak up for them. Hospitals have their own limits too. An operator, administrator, or employee of a hospital generally cannot be appointed agent by someone who is a patient or resident there at the time.