Free Health Care Proxy Forms and Templates

Use this document employed in Michigan to state your wishes in regard to your health care treatment preferences in the event of a possible mental disability.

Download this form to state your wishes regarding your preferences for your healthcare in the event you are no longer able to decide for yourself. The form is used in the state of Mississippi.

This New Hampshire-specific form is used as part of the patient's medical records. It determines health care measures to be taken in the event of the patient's mental incapacity.

This New York-specific form is used as part of the patient's medical records. It determines health care measures to be taken in the event of the patient's severe physical or mental incapacity.

Use this legal document created for Rhode Island that specifies the type of medical care that an individual does or does not want in the event they are unable to communicate their wishes. The will comes into play only when one faces a life-threatening condition and is unable to assert their specific desires regarding treatment.

This Tennessee-specific document is the patient's declaration - a written statement of what they want to occur in the event of a serious accident or illness. It is primarily addressed for the medical personnel and focuses on the type of care the patient wishes to have in situations of terminal illness or incapacitation.

Download this legal document employed in Virginia that spells out the medical treatments an individual would and would not want to be used to keep them alive. The form also clarifies the preferences for other medical decisions, such as pain management or organ donation.

Print out this will to pre-organize your health care in a potential scenario, prevent major arguments between your family members, control any necessary medical treatments and procedures and reduce potential extra medical bills in the state of Washington.

Fill out this will to determine your health care treatment in a potential scenario, prevent major arguments between your family members, control any necessary medical treatments and procedures and reduce potential extra medical bills.

This document appoints a person to make health care decisions on your behalf in the state of Arkansas.

This document allows residents of Nevada to appoint someone to make health care decisions on their behalf in case they become unable to do so.

This form is used to instruct health care providers to not do CPR for the patient if their heart stops beating.

This Form is used for providing consent to participate in the Yellow Dot Program in West Virginia. The Yellow Dot Program helps first responders quickly access vital medical information in case of an emergency.

This document for Virginia residents allows individuals to outline their preferences for medical, mental, and end-of-life care in advance. It covers a range of healthcare decisions and ensures that your wishes are honored if you are unable to communicate them yourself.

This document allows individuals in West Virginia to express their medical treatment preferences in the event they become unable to communicate them in the future.

This type of form grants agents the power to make specific medical choices in relation to the principal in the state of Arizona.

This type of form allows for an individual that resides in Florida to select themselves two agents that have the legal power to make medical decisions regarding the principal in emergency situations when the principal is not in a fit state to do so.

This type of form gives permission for an agent to represent a principal in a medical setting, allowing them to make specific choices relating to treatment and any other significant medical decisions in the state of Hawaii.

Residents of Indiana may use this type of form to give another person the legal right to represent and make medical decisions on behalf of another person.

Residents of Maine can use this form to provide an individual with the opportunity to pick a medical representative agent that will be given powers relating to medical treatment and any relevant instructions that may be required post-death.

This is a legal document that provides official permission for an agent to act on behalf of a principal in a medical setting in the state of Maryland.

This form is used in New Hampshire to allow another individual (usually a close friend or relative) the power to make important medical choices on behalf of the principal.

This type of form is used in New York and will give an agent the power to make important choices concerning treatment plans on behalf of the principal.

Residents of Oregon may use this form in cases when a principal wants to delegate themselves an agent, giving them legal permission to make vital medical decisions on their behalf.

Residents of Tennessee may use this type of form when a principal wants to create a back-up option regarding their treatment and have another individual be able to make specific choices concerning treatment.

This form legally gives permission for a principal to delegate themselves an agent in regard to medical matters in the state of Virginia.

By using this type of form in Alabama, a person may choose a representative to legally represent them in regards to their finances.

This document is a checklist for situations where adult hospital, hospice or nursing home patients in New York do not have the capacity to make medical decisions and do not have a health care proxy. It provides guidance on the use of a surrogate selected from the surrogate list according to New York's Public Health Law.

This document is a checklist for adult hospital, hospice, or nursing home patients in New York who lack medical decision-making capacity, do not have a health care proxy, and have no available surrogate from the surrogate list.

This checklist is used for adult patients in New York who lack the capacity to make medical decisions, do not have a healthcare proxy, and do not have a developmental disability. It is specifically for situations where the Molst (Medical Orders for Life-Sustaining Treatment) form is being completed in the community.