US Legal Forms
New York Revocación del poder de atención médica

Revocación del Poder Notarial de Atención Médica - New York Revocation of Health Care Proxy

State:

New York

Category:

Poder notarial - Atención médica - Revocaciones - Alaska

Control #:

NY-P020B

Format:

46 downloads

This form is part of a form package!

Get all related documents in one bundle, so you don’t have to search separately.

View package

Description

This form is a revocation of the health care proxy provided in Form NY-P020.
Para su conveniencia, debajo del texto en español le brindamos la versión completa de este formulario en inglés. For your convenience, the complete English version of this form is attached below the Spanish version.

Acuerdo para otorgar testamentos mutuos

View this form

Ejemplo de carta de invitación a despedida de soltera

View this form

Acuerdo para Ejecutar Testamento Mutuo o Conjunto y Mutuo por el Esposo y la Esposa con Herencia para el Sobreviviente

View this form

Ejemplo de carta de confianza traicionada

View this form

Acuerdo para diseñar o legar la propiedad de un negocio transferido a un socio comercial

View this form

Built-in online Word editor

Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Export easily

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

E-sign your document

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

Notarize online 24/7

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

Store your document securely

We protect your documents and personal data by following strict security and privacy standards.

Make edits, fill in missing information, and update formatting in US Legal Forms—just like you would in MS Word.

Download a copy, print it, send it by email, or mail it via USPS—whatever works best for your next step.

Sign and collect signatures with our SignNow integration. Send to multiple recipients, set reminders, and more. Go Premium to unlock E-Sign.

If this form requires notarization, complete it online through a secure video call—no need to meet a notary in person or wait for an appointment.

We protect your documents and personal data by following strict security and privacy standards.

Looking for another form?

This field is required

Lease Agreement Living Will Living Trust Home Sale Last Will and Testament Power of Attorney Quitclaim Deed Horse forms Construction Contract Contractor Agreement

Exención y liberación de responsabilidad p...

View this form

Consultant Agreement to Prepare Financial ...

View this form

Consent Statement for Consent of Stockhold...

View this form

Taxation of Costs

View this form

Request and Order for Court-Appointed Atto...

View this form

APPEAL - Record on Appeal FromChancery

View this form

Petition for Writ of Habeas Corpus by a Pe...

View this form

Loan Modification Agreement

View this form

Affidavit of Death and Heirship

View this form

Employment Contracts for Nanny or Childcar...

View this form

How to fill out New York Revocación Del Poder De Atención Médica?

When it comes to filling out New York Revocation of Health Care Proxy, you almost certainly think about an extensive process that requires choosing a perfect form among hundreds of similar ones and then having to pay out legal counsel to fill it out for you. Generally, that’s a slow and expensive option. Use US Legal Forms and pick out the state-specific template in just clicks.

In case you have a subscription, just log in and then click Download to get the New York Revocation of Health Care Proxy form.

If you don’t have an account yet but need one, keep to the point-by-point guideline listed below:

Make sure the file you’re getting is valid in your state (or the state it’s required in).
Do it by reading the form’s description and through clicking the Preview option (if available) to find out the form’s content.
Click on Buy Now button.
Select the appropriate plan for your financial budget.
Subscribe to an account and select how you want to pay out: by PayPal or by credit card.
Save the document in .pdf or .docx format.
Find the document on your device or in your My Forms folder.

Skilled lawyers work on drawing up our templates so that after saving, you don't need to bother about enhancing content material outside of your individual details or your business’s information. Be a part of US Legal Forms and get your New York Revocation of Health Care Proxy sample now.

Form popularity

Trusted and secure by over 3 million people of the world’s leading companies

Revocación del poder de atención médica

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE NEW YORK CONSOLIDATED LAWS

REVOCATION OF HEALTH CARE PROXY

(Chapter 45, Article 29-C, Â§Â§ 2980 through 2994)

Selected Definitions

An "adult" is any person who is eighteen years of age or older, or is the parent of a child, or has married.

An "attending physician" is the physician, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient.

"Capacity to make health care decisions" is the ability to understand and appreciate the nature and consequences of health care decisions, including the benefits and risks of and alternatives to any proposed health care, and to reach an informed decision.

"Health care" is any treatment, service or procedure to diagnose or treat an individual's physical or mental condition.

A "health care agent" or "agent" is an adult to whom authority to make health care decisions is delegated under a health care proxy.

A "health care decision" is any decision to consent or refuse to consent to health care.

A "health care proxy" is a document delegating the authority to make health care decisions, executed in accordance with the statutory requirements.

"Mental illness" is a mental illness as defined in subdivision twenty, Â§ 1.03 Mental Hyg. of the mental hygiene law. Provided, however, that mental illness does not include dementia, such as alzheimer's disease or other disorders related to dementia.

A "principal" is a person who has executed a health care proxy.

Appointment of Agent

A competent adult may appoint a health care agent in accordance with the statutory requirements.

An adult is presumed competent to appoint a health care agent unless:

such person has been adjudged incompetent or otherwise adjudged not competent to appoint a health care agent; or

unless a committee or guardian of the person has been appointed for the adult pursuant to article seventy-eight of the mental hygiene law or article seventeen-A of the surrogate's court procedure act.

Execution and Witnesses

A competent adult may appoint a health care agent by a health care proxy, signed and dated by the adult in the presence of two adult witnesses. The witnesses must also sign the proxy.

Another person may sign and date the health care proxy for the adult if the adult is unable to do so, at the adult's direction and in the adult's presence, and in the presence of two adult witnesses who must also sign the proxy.

The witnesses must state that the principal appeared to execute the proxy willingly and free from duress.

The person appointed as agent shall not act as witness to execution of the health care proxy.

If a person resides in a mental hygiene facility operated or licensed by the office of mental health, at least one witness must be an individual who is not affiliated with the facility and, if the mental hygiene facility is also a hospital as defined in subdivision ten of Â§ 1.03 Mental Hyg. of the mental hygiene law, at least one witness shall be a qualified psychiatrist.

If a person resides in a mental hygiene facility operated or licensed by the office of mental retardation and developmental disabilities,

at least one witness must be an individual who is not affiliated with the facility and

at least one witness shall be a physician or clinical psychologist who is either

employed by a school named in section 13.17 Mental Hyg. of the mental hygiene law or

who has been employed for a minimum of two years to render care and service in a facility operated or licensed by the office of mental retardation and developmental disabilities, or

who has been approved by the commissioner of mental retardation and developmental disabilities in accordance with regulations approved by the commissioner.

Restrictions and Limitations on a Health Care Agent.

An operator, administrator or employee of a hospital may not be appointed as a health care agent by any person who, at the time of the appointment, is a patient or resident of, or has applied for admission to, such hospital. This restriction does not apply to:

an operator, administrator or employee of a hospital who is related to the principal by blood, marriage or adoption; or

a physician (subject to the limitation set forth below), except that no physician affiliated with a mental hygiene facility or a psychiatric unit of a general hospital may serve as agent for a principal residing in or being treated by such facility or unit unless the physician is related to the principal by blood, marriage or adoption.

If a physician is appointed agent, the physician shall not act as the patient's attending physician after the authority under the health care proxy commences.

No person who is not the spouse, child, parent, brother, sister or grandparent of the principal, or is the issue of, or married to such person, shall be appointed as a health care agent if, at the time of appointment, he or she is presently appointed health care agent for ten principals.

Form

The statutory form is not required. However, any health care proxy must:

identify the principal and agent; and

indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf.

A health care proxy may

include the principal's wishes or instructions about health care decisions, and limitations upon the agent's authority;

provide that it expires upon a specified date or upon the occurrence of a certain condition. If no such date or condition is set forth in the proxy, the proxy shall remain in effect until revoked.

If, prior to the expiration of a proxy, the authority of the agent has commenced, the proxy shall not expire while the principal lacks capacity.

A health care proxy cannot be executed on a form or other writing that also includes the execution of a power of attorney.

Agent's Authority

An agent's authority commences upon a determination that the principal lacks capacity to make health care decisions.

Alternate Agent

A competent adult may designate an alternate agent in the health care proxy to serve in place of the agent when the attending physician has determined in a writing signed by the physician that:

the person appointed as agent is not reasonably available, willing and competent to serve as agent, and

that such person is not expected to become reasonably available, willing and competent to make a timely decision given the patient's medical circumstances.

An agent may be disqualified from acting on the principal's behalf pursuant to statutory provisions or under conditions set forth in the proxy.

If, after an alternate agent's authority commences, the person appointed as the initial agent becomes available, willing and competent to serve as agent:

the authority of the alternate agent shall cease and the authority of the agent shall commence; and

the attending physician shall record the change in agent and the reasons therefor in the principal's medical record.

Obligations and Rights of Agent

Subject to any express limitations in the health care proxy, an agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make.

After consultation with a licensed physician, registered nurse, licensed clinical psychologist or certified social worker, an agent shall make health care decisions:

in accordance with the principal's wishes, including the principal's religious and moral beliefs; or

if the principal's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the principal's best interests; provided, however, that if the principal's wishes regarding the administration of artificial nutrition and hydration are not reasonably known and cannot with reasonable diligence be ascertained, the agent shall not have the authority to make decisions regarding these measures.

An agent has the right to receive medical information and medical and clinical records necessary to make informed decisions regarding the principal's health care.

Revocation

A competent adult may revoke a health care proxy by notifying the agent or a health care provider orally or in writing or by any other act evidencing a specific intent to revoke the proxy.

A health care proxy may be revoked upon execution by the principal of a subsequent health care proxy.

The appointment of the principal's spouse as health care agent is automatically revoked upon the divorce or legal separation of the principal and spouse, unless the principal specifies otherwise.

A physician who is informed of or provided with a revocation of a health care proxy must immediately record the revocation in the principal's medical record and notify the agent and the medical staff responsible for the principal's care of the revocation.

Revocación del poder de atención médica

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE NEW YORK CONSOLIDATED LAWS

REVOCATION OF HEALTH CARE PROXY

(Chapter 45, Article 29-C, Â§Â§ 2980 through 2994)

Selected Definitions

An "adult" is any person who is eighteen years of age or older, or is the parent of a child, or has married.

An "attending physician" is the physician, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient.

"Health care" is any treatment, service or procedure to diagnose or treat an individual's physical or mental condition.

A "health care agent" or "agent" is an adult to whom authority to make health care decisions is delegated under a health care proxy.

A "health care decision" is any decision to consent or refuse to consent to health care.

A "health care proxy" is a document delegating the authority to make health care decisions, executed in accordance with the statutory requirements.

A "principal" is a person who has executed a health care proxy.

Appointment of Agent

A competent adult may appoint a health care agent in accordance with the statutory requirements.

An adult is presumed competent to appoint a health care agent unless:

such person has been adjudged incompetent or otherwise adjudged not competent to appoint a health care agent; or

unless a committee or guardian of the person has been appointed for the adult pursuant to article seventy-eight of the mental hygiene law or article seventeen-A of the surrogate's court procedure act.

Execution and Witnesses

A competent adult may appoint a health care agent by a health care proxy, signed and dated by the adult in the presence of two adult witnesses. The witnesses must also sign the proxy.

The witnesses must state that the principal appeared to execute the proxy willingly and free from duress.

The person appointed as agent shall not act as witness to execution of the health care proxy.

If a person resides in a mental hygiene facility operated or licensed by the office of mental retardation and developmental disabilities,

at least one witness must be an individual who is not affiliated with the facility and

at least one witness shall be a physician or clinical psychologist who is either

employed by a school named in section 13.17 Mental Hyg. of the mental hygiene law or

who has been employed for a minimum of two years to render care and service in a facility operated or licensed by the office of mental retardation and developmental disabilities, or

who has been approved by the commissioner of mental retardation and developmental disabilities in accordance with regulations approved by the commissioner.

Restrictions and Limitations on a Health Care Agent.

an operator, administrator or employee of a hospital who is related to the principal by blood, marriage or adoption; or

a physician (subject to the limitation set forth below), except that no physician affiliated with a mental hygiene facility or a psychiatric unit of a general hospital may serve as agent for a principal residing in or being treated by such facility or unit unless the physician is related to the principal by blood, marriage or adoption.

If a physician is appointed agent, the physician shall not act as the patient's attending physician after the authority under the health care proxy commences.

Form

The statutory form is not required. However, any health care proxy must:

identify the principal and agent; and

indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf.

A health care proxy may

include the principal's wishes or instructions about health care decisions, and limitations upon the agent's authority;

provide that it expires upon a specified date or upon the occurrence of a certain condition. If no such date or condition is set forth in the proxy, the proxy shall remain in effect until revoked.

If, prior to the expiration of a proxy, the authority of the agent has commenced, the proxy shall not expire while the principal lacks capacity.

A health care proxy cannot be executed on a form or other writing that also includes the execution of a power of attorney.

Agent's Authority

An agent's authority commences upon a determination that the principal lacks capacity to make health care decisions.

Alternate Agent

A competent adult may designate an alternate agent in the health care proxy to serve in place of the agent when the attending physician has determined in a writing signed by the physician that:

the person appointed as agent is not reasonably available, willing and competent to serve as agent, and

that such person is not expected to become reasonably available, willing and competent to make a timely decision given the patient's medical circumstances.

An agent may be disqualified from acting on the principal's behalf pursuant to statutory provisions or under conditions set forth in the proxy.

If, after an alternate agent's authority commences, the person appointed as the initial agent becomes available, willing and competent to serve as agent:

the authority of the alternate agent shall cease and the authority of the agent shall commence; and

the attending physician shall record the change in agent and the reasons therefor in the principal's medical record.

Obligations and Rights of Agent

Subject to any express limitations in the health care proxy, an agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make.

After consultation with a licensed physician, registered nurse, licensed clinical psychologist or certified social worker, an agent shall make health care decisions:

in accordance with the principal's wishes, including the principal's religious and moral beliefs; or

if the principal's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the principal's best interests; provided, however, that if the principal's wishes regarding the administration of artificial nutrition and hydration are not reasonably known and cannot with reasonable diligence be ascertained, the agent shall not have the authority to make decisions regarding these measures.

An agent has the right to receive medical information and medical and clinical records necessary to make informed decisions regarding the principal's health care.

Revocation

A competent adult may revoke a health care proxy by notifying the agent or a health care provider orally or in writing or by any other act evidencing a specific intent to revoke the proxy.

A health care proxy may be revoked upon execution by the principal of a subsequent health care proxy.

The appointment of the principal's spouse as health care agent is automatically revoked upon the divorce or legal separation of the principal and spouse, unless the principal specifies otherwise.

Revocación del Poder Notarial de Atención Médica - New York Revocation of Health Care Proxy

This form is part of a form package!

Description

Related forms

Get your form ready online

Looking for another form?

Viewed forms

How to fill out New York Revocación Del Poder De Atención Médica?

Form popularity

Trusted and secure by over 3 million people of the world’s leading companies

Revocación del Poder Notarial de Atención Médica - New York Revocation of Health Care Proxy

This form is part of a form package!

Description

Related forms

Get your form ready online

Looking for another form?

Viewed forms

How to fill out New York Revocación Del Poder De Atención Médica?

Form popularity

Revocación del Poder Notarial de Atención Médica Related Searches

Trusted and secure by over 3 million people of the world’s leading companies