Get Nys Fillable Health Proxy Form

Filling out the Nys Fillable Health Proxy Form is an important step in ensuring your healthcare preferences are honored. This guide provides a clear and supportive walkthrough to help you complete the form online, making it accessible and easy to follow for all users.

Follow the steps to fill out the form accurately and efficiently.

1. Click ‘Get Form’ button to obtain the form and open it in the online editor.
2. Enter your full name, home address, and phone number in the designated fields to identify yourself as the person appointing a health care agent.
3. Designate your health care agent by entering their name, home address, and phone number. This person will have the authority to make health care decisions on your behalf.
4. If desired, appoint an alternate agent by filling in their name, home address, and phone number. This provides a backup decision-maker if your primary agent is unavailable.
5. Specify the expiration conditions for the proxy, if any, by stating a date or circumstances under which the proxy will no longer be valid.
6. Outline any limitations or specific instructions for your health care agent regarding your treatment preferences.
7. Provide your printed name, signature, address, and the date of signing the form to validate your health care proxy.
8. If you wish to facilitate organ or tissue donation, check applicable options and specify limitations if needed. Sign and date this section.
9. Have two witnesses (who are 18 years or older and not your appointed agents) sign the document. Their printed names, signatures, and addresses must be included.
10. After completing the form, save your changes. You can also download, print, or share the form as necessary.

Complete your health proxy form online today to ensure your medical preferences are respected.