Guides · State guides · New York
New York Health Care Proxy Form: How to Fill It Out, Sign It, and Use It
The health care proxy is how New York lets your parent name who makes medical decisions for them. It takes two adult witnesses and no notary.
By naveen · Updated · How we research our guides
What to know
- A New York health care proxy must be signed and dated by your parent in front of two adult witnesses who also sign, and the agent can't be a witness (Public Health Law §2981).
- In the New York Attorney General's words: "You don't need a lawyer or a notary, just two adult witnesses."
- The Department of Health publishes the form as a fillable PDF in English and twelve other languages, and your parent doesn't have to use that form.
- The agent's authority starts only when the attending practitioner determines in writing that your parent lacks capacity.
- Retirement Checklist puts the proxy in order with everything else your family needs to settle.
The New York health care proxy form is the document your parent uses to appoint a health care agent, the person who makes medical decisions for them if they can't. Your parent signs and dates it in front of two adult witnesses, who sign it too, under Public Health Law §2981. The New York Attorney General puts it plainly: "You don't need a lawyer or a notary, just two adult witnesses."
What is a health care proxy in New York?
It's New York's document for naming a health care agent. "A competent adult may appoint a health care agent" by a health care proxy (§2981), and every adult is presumed competent to do so unless a court has ruled otherwise or a guardian has been appointed.
Unless your parent limits it, the agent can make any health care decision your parent could make. It's a health care document only. The Attorney General notes that the form "does not give your agent the power to make non-health care decisions for you, such as financial decisions." Money is handled by a separate New York power of attorney. For how proxies relate to living wills and other directives, see our guide to advance directives, living wills and medical power of attorney.
Where do you get the New York health care proxy form?
From the New York State Department of Health, which publishes a "Health Care Proxy Fillable PDF with Instructions." It's available in English, Spanish, Chinese, Haitian Creole, Italian, Korean, Russian, Yiddish, Polish, French, Bengali, Arabic and Urdu.
Your parent doesn't have to use it. The Attorney General's page says, "You can use the form printed here, but you don't have to use this form." Whatever version your parent uses, it must meet the signing rules below, and it can't be combined with a power of attorney: a health care proxy "shall not be executed on a form or other writing that also includes the execution of a power of attorney" (§2981).
The form can also record wishes about organ and tissue donation. Leaving that blank isn't read as a wish not to donate.
How do you sign a New York health care proxy?
Your parent signs and dates it in front of two adult witnesses, who sign it too; the agent can't be one of them, and no notary is needed.
| Requirement | What New York law says |
|---|---|
| Your parent | Signs and dates the proxy |
| Witnesses | Two adults, who also sign |
| What witnesses state | That your parent appeared to sign willingly and free from duress |
| The agent | Can't be a witness |
| Notary | Not required, per the Attorney General |
| If your parent can't sign | Another person signs and dates for them, at their direction and in their presence, before the two witnesses |
| Combined with a power of attorney | Not allowed on the same form |
Two special cases exist. Residents of mental health or developmental disability facilities operated or licensed by the state need at least one witness unaffiliated with the facility, plus a qualified professional witness in some settings. And New York permits witnessing by audio-video technology, for one or both witnesses, if your parent shows photo ID to a remote witness they don't know, the call allows direct interaction, the remote witness receives a legible copy within 24 hours, and the remote witness signs that copy and sends it back.
Who can be the health care agent?
Any adult your parent chooses, subject to two restrictions in §2981 (the statute defines a health care agent as an adult, in §2980):
- An operator, administrator or employee of a hospital can't be appointed by someone who is a patient or resident of, or has applied to, that hospital, unless they're related by blood, marriage or adoption, or are a physician, physician assistant or nurse practitioner, who then can't also act as your parent's attending practitioner.
- A person who isn't a close relative can't be appointed if they're already the agent for ten people.
Your parent can also name an alternate agent, who steps in if the first can't serve. The agent can't be a witness to the proxy.
When does the agent start making decisions?
Only once your parent can't decide for themselves: the agent's authority "shall commence upon a determination" that "the principal lacks capacity to make health care decisions" (§2981). Under §2983, the attending practitioner makes that determination "to a reasonable degree of medical certainty," in writing, in the medical record, and must consult another physician, physician assistant or nurse practitioner to confirm it before a decision to withdraw or withhold life-sustaining treatment.
The Attorney General adds the practical point: "As long as you are able to make health care decisions for yourself, you will have the right to do so." If your parent regains capacity, the agent's authority stops.
If you need to speak with your parent's doctors while your parent is still deciding for themselves, see our guide to HIPAA authorization.
What can the agent decide?
Unless your parent limits the agent's authority, "your agent will be able to make any health care decision that you could have made," according to the Attorney General. That includes agreeing to treatment, choosing among treatments, and deciding treatments should not be provided, in line with your parent's wishes.
One limit is worth knowing before your parent signs: the agent "can only make decisions about artificial nutrition and hydration (nourishment and water provided by feeding tube or intravenous line) if he or she knows your wishes from what you have said or what you have written." If the agent doesn't know your parent's wishes on a question, "your agent is legally required to act in your best interest."
What happens if your parent has no health care proxy?
For decisions about care in a hospital, and hospice care wherever it's provided, New York's Family Health Care Decisions Act names a surrogate (§2994-b). Under §2994-d, the surrogate is one person from the highest available class:
- a court-appointed guardian authorized to decide about health care;
- a spouse, if not legally separated, or a domestic partner;
- a son or daughter aged 18 or older;
- a parent;
- a brother or sister aged 18 or older;
- a close friend.
The statute makes one person from that list the surrogate, not a group. A proxy lets your parent choose the person in advance; our guide to siblings and caring for a parent covers dividing the work.
How do you revoke a health care proxy in New York?
Your parent can revoke it "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" (§2985). Signing a new proxy also revokes the old one. If the agent is your parent's spouse, divorce or legal separation revokes that appointment unless your parent specified otherwise.
Writing down wishes or limits later doesn't revoke the proxy unless those writings say so.
Who should have a copy?
The Department of Health suggests giving a copy of the completed form "to your proxy, primary care provider and other family members," and adds, "It is also a good idea to carry a copy in your wallet or purse, in case of emergencies."
What questions are worth asking before your parent signs?
- Who should be the agent, and who is the alternate?
- Has your parent told the agent their wishes about feeding tubes and IV fluids?
- Which two adults will witness, and is neither of them the agent?
- Should the form include organ and tissue donation wishes?
- Who will hold copies?
Frequently asked questions
Does a health care proxy need to be notarized in New York?
No. The New York Attorney General says, "You don't need a lawyer or a notary, just two adult witnesses." Public Health Law §2981 requires your parent to sign and date the proxy in front of two adult witnesses, who also sign it. The agent can't be one of the witnesses.
Where can I get a New York health care proxy form?
The New York State Department of Health publishes a fillable PDF with instructions on its website, in English and twelve other languages, including Spanish, Chinese, Russian and Yiddish. Your parent doesn't have to use that version, as long as the proxy they use meets the signing rules.
Who can be a witness to a New York health care proxy?
Any two adults except the person named as agent. The witnesses state that your parent appeared to sign willingly and free from duress. Residents of certain state-licensed mental health or developmental disability facilities have extra witness requirements, and witnessing by audio-video is allowed under set conditions.
Can a health care proxy and power of attorney be on the same form in New York?
No. Public Health Law §2981 says a health care proxy shall not be executed on a form that also includes the execution of a power of attorney. Your parent needs two separate documents: a health care proxy for medical decisions and a power of attorney for finances.
Who decides for my parent in New York if there is no health care proxy?
For hospital care and hospice care, the Family Health Care Decisions Act names one surrogate from the highest available class: a guardian, then a spouse or domestic partner, then an adult child, then a parent, then an adult sibling, then a close friend, under Public Health Law §2994-d.
Can my parent cancel a health care proxy?
Yes. Your parent can revoke it by telling the agent or a health care provider, orally or in writing, or by any other act showing a specific intent to revoke, under §2985. Signing a new proxy also revokes the old one. Every adult is presumed competent to do this unless a court has decided otherwise.
Getting started
A health care proxy is time-sensitive, because it needs your parent's signature while they're able to make the choice. The plan this site builds asks four questions, including which state your parents live in, and puts the steps that matter most for your family in order. It's free and takes about 90 seconds.
Related guides
Sources
- New York Public Health Law §2981, Appointment of health care agent; health care proxy: signing, witnesses, agent restrictions, when authority begins.
- New York Public Health Law §2980, Definitions: a health care agent is an adult.
- New York Public Health Law §2983, Determination of lack of capacity: how incapacity is determined.
- New York Public Health Law §2985, Revocation: how a proxy is revoked.
- New York Public Health Law §2994-d, Health care decisions by surrogates: the surrogate list when there's no proxy.
- New York Attorney General, Health Care Proxy: no notary needed; what the agent can decide.
- New York State Department of Health, Health Care Proxy: the official fillable form and languages.
More on what this tool does and doesn't do, or browse everything we've written.