New York State Health Care Proxy Form

External

This form from the State of New York allows you to identify someone who can make decisions on your behalf if you’re not able to make them for yourself. To view this resource, click “View and Print as PDF” on the right.
If you have any questions or concerns, contact a member of your healthcare team directly or call 212-639-2000 for help.
If you have any questions or concerns, talk with a member of your healthcare team. You can reach them Monday through Friday from 9:00 am to 5:00 pm at ____________________. After 5:00 pm, during the weekend, and on holidays, please call____________________. If there’s no number listed, or you’re not sure, call 212-639-2000.
New York State Health Care Proxy Form
©2019 Memorial Sloan Kettering Cancer Center - Generated on January 18, 2019

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