Checklist #4: Adult Hospital, Hospice or Nursing Home Patients Without Medical Decision-Making Capacity Who Do Not Have a Health Care Proxy and for Whom No Surrogate From the Surrogate List Is Available is a legal document that was released by the New York State Department of Health - a government authority operating within New York.
Q: Who does this checklist apply to?
A: This checklist applies to adult hospital, hospice, or nursing home patients without medical decision-making capacity who do not have a health care proxy and for whom no surrogate from the surrogate list is available in New York.
Q: What is a health care proxy?
A: A health care proxy is a legal document that allows an individual to appoint someone to make medical decisions on their behalf if they become unable to do so themselves.
Q: What is a surrogate list?
A: A surrogate list is a list of individuals who can act as a patient's surrogate decision-maker if they do not have a health care proxy.
Q: What happens if a patient does not have a health care proxy and no surrogate from the surrogate list is available?
A: In New York, a checklist is followed for adult hospital, hospice, or nursing home patients in this situation to ensure medical decisions are made in their best interest.
Q: What is the purpose of this checklist?
A: The purpose of this checklist is to provide guidance on the appropriate steps to be taken when making medical decisions for patients without medical decision-making capacity who do not have a health care proxy and for whom no surrogate from the surrogate list is available.
Form Details:
Download a printable version of the form by clicking the link below or browse more documents and templates provided by the New York State Department of Health.