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DOH-1430 2022-2025 free printable template

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This document enables individuals to appoint a health care agent who can make medical decisions on their behalf if they are unable to do so. It outlines the responsibilities and authority of the appointed
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Who needs a Health Care Proxy Form?

A Health Care Proxy is the form designed to be used in the New York State by an individual who wish to encharge another person (a close friend or a family member) to take health care decisions in case the applicant becomes unable to make decisions on their own.

What is the Health Care Proxy Form for?

New York State Health Care Proxy is a legal document that makes possible to indicate a person who you trust to make health care decisions for you and in advance give consideration to agreeable treatment options. However, this will be possible only in case if your health care provider claims you unable to decide on your own.

Is Health Care Proxy Form accompanied by other forms?

No, there is no need to add any attachments to this form.

When is Health Care Proxy Form due?

Filing of the Form is voluntary and can be done at any point of time.

As for the Health Proxy validity period, it can be specified in the form as a certain date or if certain event occurs. If the end date is not specified, the NYS Health Care Proxy shall be considered termless.

In case, you want to change a person appointed, you should simply file a new form.

If the person appointed is your spouse, and you get legally divorced or separated the Health Proxy will become no longer valid. (Unless other is specified in the signed form).

How do I fill out the Health Care Proxy Form?

The Health Care Proxy must be filled out in front of two adult witnesses.

As for the contents, there is a thorough instruction at the beginning of Form.

Where do I send the Health Care Proxy Form?

A copy of the Health Care Proxy should be directed to the person appointed as an agent, filer’s attorney, doctor and other persons considered appropriate (family members and friends). The original copy should be kept in an easily accessible place. If you get into the hospital, take a copy of your Health Care Proxy too.

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People Also Ask about

In the case of a Health Care Proxy, a trusted loved one will be given the responsibility. However, with an Advance Directive, your decisions regarding medical intervention and end-of-life preferences are clearly stated in a legally binding document rather than a living person.
A health proxy is an estate planning document that allows you to name another individual who will make medical decisions for you if you become incapacitated. In other words, if you are unable to speak for yourself, this proxy is legally authorized to communicate your wishes and make decisions on your behalf.
A DNR says that if your heart stops or you stop breathing, medical professionals should not attempt to revive you. This is very different from a health care proxy, which only goes into effect if you are unable to communicate your wishes for care.
Listen to pronunciation. (HELTH kayr PRAK-see) A type of advance directive that gives a person (such as a relative, lawyer, or friend) the authority to make healthcare decisions for another person.
Listen to pronunciation. (HELTH kayr PRAK-see) A type of advance directive that gives a person (such as a relative, lawyer, or friend) the authority to make healthcare decisions for another person.
How do you get a healthcare proxy? You can create a healthcare proxy by using a state-specific form, or have an online legal service prepare your healthcare proxy for you. You can also have an attorney prepare the document.

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