Free Health Care Proxy Forms and Templates
What Is a Health Care Proxy Form?
A Health Care Proxy Form is a legal document which names someone else as an individual's health caretaker whenever that individual is temporarily or permanently unable to think critically and make important decisions about their health and treatment. In the majority of cases people opt to pick a trustworthy individual such as a close friend or relative that they are confident in to make the right decisions in the best interests of the individual.
By downloading a blank Health Care Proxy Form, anyone may quickly create, modify and send off the form while still meeting HIPAA requirements. This will help develop a competent, HIPAA approved document which meets the specific requirements of each individual.
An individual may ensure that medical professionals adhere to their wishes by selecting an agent. Furthermore, as the clinical state evolves, the agent may select the way in which your preferences are implemented. Clinics, physicians, as well as other health professionals should abide by the choices of your agent as if the choices were made personally by the individual. An agent can be granted as much power as an individual would like. It is possible to delegate some or all health-related choices to the agent. Additionally, you can offer the agent directives which they must abide by.
For a full list of Health Care Proxy Form templates please feel free to check out our library below.
Living Will Vs Health Care Proxy
Often people can confuse a Living Will and a Health Care Proxy and some can use these two terms interchangeably. This, however, is incorrect because the two documents are completely different in nature and are responsible for very different things.
The latter selects an agent to make clinical choices for you and in your interests if you no longer have the ability to do this independently. On the other hand, a Living Will enables an individual to select medical interventions which you would be happy to receive as well as those that you are strongly opposed to in the event that an individual faces a terminal illness and is incapable of making sound choices independently.
It is important to consider federal regulations governing health and the rights of individuals; it is largely a state-dependent matter. Therefore, prior to putting your signature on any health-related document, the individual should be completely sure that they are aware of the laws and regulations that apply to a particular state. If they are not certain about the differences and the various nuances that both of these documents present, they should speak with a lawyer before taking any actions or making any decisions.
How to Get a Health Care Proxy?
In order to obtain a Health Care Proxy, you first should find an appropriate template that you can edit and personalize, tailoring the document to the specific needs of an individual. Once you have done this, you must fill in the form:
- State who you have chosen to be your agent. You should also include their contact details. You also have the right to select an alternate agent and if you desire to do so, include their details too;
- If you want to include a time limit for the proxy, you should clearly state this otherwise it will be valid indefinitely;
- In the following section, you may include any additional guidelines that you might want to implement for your agent. An individual also has the right to specify any restrictions on an agent's power in this section. It is important to note that an agent will be able to execute any healthcare decisions that normally the individual would have made themselves, this includes whether to agree to or deny life-saving treatment, if there is no specificity about any restrictions;
- You should also add your own contact details, sign the document and include the date;
- If donating your organs is something that you would like to consider, you can make this wish known towards the end of the form;
- There is no requirement for this to be signed before a notary public. However, there should be at least two witnesses that are over the legal age and these individuals cannot be the named proxy in the form.
Haven't found the form you're looking for? Take a look at the related templates and forms below:
Documents:
91
This document is used for planning your medical care in advance, specifying your preferences and appointing a healthcare proxy to make decisions on your behalf. It is specific to the state of Alabama.
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This document is used for designating a person to make medical decisions on your behalf in the event that you are unable to do so. It is specific to the state of New York.
This document allows Indiana residents to choose someone to make healthcare decisions on their behalf if they are unable to do so.
This document enables a designated person to make emergency health care decisions for your minor child in the state of Washington.
This Form is used for creating an Advance Directive for Health Care in the state of Virginia. It allows individuals to make decisions about their medical treatment in the event they become unable to communicate their wishes.
This type of document, called a Health Care Proxy Form, is used in New York to appoint a person to make medical decisions on your behalf if you are unable to do so.
This form is used for expressing your wishes regarding healthcare decisions in Minnesota, in accordance with the Honoring Choices program.
This document provides information about your rights regarding advance directives.
This document outlines an individual's wishes and preferences for medical treatment and care in the state of Minnesota. It allows them to appoint a healthcare agent and specify their decisions regarding life-sustaining treatment and end-of-life care.
This type of document is used for creating an Advance Health Care Directive in Newfoundland and Labrador, Canada. It allows individuals to specify their preferences for medical treatment and appoint a substitute decision-maker in case they cannot make decisions for themselves.
This checklist is for adult hospital, hospice or nursing home patients in New York who do not have the capacity to make medical decisions and do not have a health care proxy. It outlines the steps for selecting a surrogate from the surrogate list, who will make decisions on behalf of the patient.
This Form is used for adult patients in New York who do not have a health care proxy and are completing a Molst form in the community.
This legal form encompasses the orders concerning your wishes about your future medical care in the state of Alabama. The document comes into play in the event of severe medical situations in which you are not able to communicate your wishes or make decisions.
Download this Arizona-specific Advance Directive for Health Care and consult your Area Agency on Aging, a lawyer, or financial planner before signing.
This Arkansas document encompasses the orders concerning your wishes about your future medical care. The document comes into play in the event of severe medical situations in which you are not able to communicate your wishes or make decisions.
Use this document to give directives surrounding your future medical care in the state of California.
Download this Colorado form for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.
Download this Hawaii form to state your preferences for your healthcare in the event you are no longer able to decide for yourself.
Use this Illinois-specific form for cases when you are not able to communicate your wishes or make decisions. These may include directions regarding the use of mechanical ventilation or feeding tubes, as well as certain surgeries and medications.
Download this Kansas form to state your preferences for your healthcare in the event you are no longer able to decide for yourself.
This form is used in Kentucky as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.
Use this form in the state of Maine for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.
Use this Minnesota-specific form for cases when you are not able to communicate your wishes or make decisions. These may include directions regarding the use of mechanical ventilation or feeding tubes, as well as certain surgeries and medications.
Use this form in the state of Mississippi for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.
These are Missouri-specific written instructions about future medical care should you become unable to make decisions (for example, unconscious or too ill to communicate).
Use this form in the state of New Hampshire for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.
Download this New Mexico form to state your preferences for your healthcare in the event you are no longer able to decide for yourself.
This form is used in New York as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.
These are Oklahoma-specific written instructions about future medical care should you become unable to make decisions (for example, unconscious or too ill to communicate).
Download this Oregon form to state your preferences for your healthcare in the event you are no longer able to decide for yourself.
This form is used in Pennsylvania as part of the patient's medical records and determines health care measures to be taken in the event of the patient's mental or physical incapacity.
Use this form in the state of South Carolina for a potential situation when a medical issue leaves you unable to express your wishes about medical treatment.
These are South Dakota-specific written instructions about future medical care should you become unable to make decisions (for example, unconscious or too ill to communicate).
Use this Wisconsin-specific form for cases when you are not able to communicate your wishes or make decisions. These may include directions regarding the use of mechanical ventilation or feeding tubes, as well as certain surgeries and medications.
Use this Alaska-specific document to state your wishes in regard to your health care treatment preferences in the event of a possible mental disability.
This form serves as written directives of the Colorado patient wishing to express their desires regarding their medical treatment in the event of their potential mental incapacity.
Fill out this document to indicate your wishes about the health care measures to be taken in the event of your possible mental incapacity.
This Maryland-specific form allows an individual to clarify their wishes regarding health care and treatment in case of temporary or permanent incapacity.
