This information explains the role of a health care agent and how you can name one using the Health Care Proxy form.
What is a health care agent?
A health care agent is someone you appoint to make health care decisions for you. Your health care agent can only do this if you are unable to do it yourself. For example, if you are asleep during surgery, you could not make a health care decision.Back to top
Can I have more than one health care agent?
Sometimes, medical decisions need to be made quickly. In that case, your doctor would want to speak with your health care agent as soon as possible. You may decide to appoint a second health care agent. Then, if your first choice was not available, your doctor could call the second choice. This person would assume the role only if the doctor could not reach your first choice. You can have only one person act for you at one time.Back to top
What is a health care proxy form?
A health care proxy form lets you name your health care agent. You must sign and date the form. You must also have two witnesses sign it. You do not need a lawyer or a notary. You can write in what you would and would not want done if you could not make your own health care decisions. Give a copy of the form to your health care agent.Back to top
What kinds of decisions can my health care agent make?
Your health care agent can make most health care decisions for you if you cannot make them yourself. For example, your agent can decide if you should have:
- More treatment
- Different treatment
- No treatment
Are there things my health care agent cannot do?
- Your health care agent cannot make decisions for you if you are able to make them yourself.
- Your health care agent cannot make financial decisions.
- Your health care agent cannot decide about nutrition or fluids unless:
- You have told your health care agent what you want or
- You have put your wishes about nutrition and fluids on your health care proxy form.
Who can I ask to be my health care agent?
You can ask a family member, friend, or anyone you trust to be your health care agent. Your agent must be at least 18 years old. It cannot be your doctor or any other member of your health care team.Back to top
How will my health care agent know what I want?
First, you must ask the person you trust if he or she is willing to be your agent. Some people do not want that responsibility. Once you have chosen an agent, you must tell that person what you want. Some topics you should discuss with your agent are:
- Would you want your health care team to try to restart your heart if it stops beating?
- Would you want to be on a respirator? A respirator is a machine that helps your lungs to breathe.
- Would you want to have a feeding tube?
Your care goals may change over time. You may change your mind about what you do and do not want. Please keep your agent informed so he or she can follow your wishes. If your agent does not agree with the changes, you may appoint a new agent.Back to top
What do I do with the health care proxy form?
The most important thing is to give it to your doctor. If you have more than one doctor, each one should have a copy. It will then be placed in your medical record so everyone who cares for you can see it. Give a copy of the proxy form to your agent(s). Your family members or friends should know who your agent is. Keep your own copy of the proxy form where your family can easily find it. Take a copy with you if you are admitted to a hospital or having surgery. Give it to the surgeon or nurse when you come for pre-surgical testing, or on the day of your surgery.Back to top
What is the difference between a living will and a health care proxy form?
A living will gives specific instructions to your health care team and to your agent. It tells them what you would and would not want if you could not make health care decisions yourself. A living will does not name someone to make health care decisions for you if you cannot make them yourself. This is what a health care proxy form does. You do not need a living will in New York.
You can get more information by calling a patient representative at 212-639-7202.Back to top
You can download healthcare proxy forms for New York State at: http://www.health.state.ny.us/professionals/patients/health_care_proxy/…
And atBack to top
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.