New York Medical Power of Attorney Form

The New York Medical Power of Attorney or “health care proxy” delivers an official nomination to an alternate party to gain authority to make decisions related to the health care treatment of a declaring individual. The instituted agency granted to the attorney-in-fact allows medical professionals to legally take instruction from someone other than the patient in cases where they may be unable to speak for themselves. Preparing the provided document is generally a preconceived arrangement put into place should the possibility of incapacitation arise.

Laws

Definition – “Health care proxy” means a document delegating the authority to make health care decisions, executed in accordance with the requirements of this article (§ 29C-2980(8)).

Signing Requirements – Two (2) witnesses must serve to review and substantiate the act of endorsement to authenticate the event (§ 29C-2981.2).

Revocation – § 29C-2985

Other Versions (5)

Archdiocese of New York Version (also available in Spanish/en Español)

Compassion and Support New York Version (also available in Spanish/en Español)

eForms Version

New York State Senate Version

Rochester Regional Health Version

Additional Resources

Related Forms (5)

Advance Directive (Medical POA & Living Will)

Advance Directive Wallet Card

Durable (Financial) Power of Attorney

Medical Orders for Life-Sustaining Treatment (MOLST)

Nonhospital Order Not to Resuscitate (DNR Order) (also available in Spanish/en Español)