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How To File a Health Care Proxy

Tragedy can strike when you least expect it. That's why it's important to be prepared to protect your wishes in case you ever fall ill.

Instructions

  • TIP: You have the right to make health care decisions for yourself as long as you are able to do so, regardless of the proxy appointment.
  • Step 1: Ask two adult witnesses, not including the proxy, to sign your form.
  • Step 2: Give a copy of the form to your agent, your doctor, and your health plan so that it becomes part of your medical record. Give copies to your attorney and family members or close friends, and bring a copy whenever you are admitted to the hospital.
  • FACT: A simple power of attorney does not entitle the bearer to make health care decisions on behalf of a patient – this must be done by a health care proxy.
  • Step 3: Sign and date the health care proxy form. Include your address.
  • TIP: Set an expiration date or a condition of expiration if you wish for the health care proxy's appointment to expire. Otherwise, the proxy document will remain valid indefinitely.
  • Step 4: Discuss your specific health care wishes, such as artificial nutrition and respiration and organ and tissue donation with your agent.
  • Step 5: Obtain a health care proxy form from your hospital or your State's Department of Health web site, or create your own document on your computer.
  • Step 6: Write the name, home address, and telephone number of the person you are selecting as your agent.
  • Step 7: Write down any specific wishes or instructions on the health care proxy document or indicate that the proxy has the authority to make any and all decisions. Also, explain any ways you wish to limit your agent's authority.
  • Step 8: Select an adult 18 years of age or older to be your agent. Discuss the responsibilities with them to make sure they are willing to act as your health care proxy.

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