Health Care Proxy Form

There are lots of conditions when a person needs assistance in taking care of health by someone else due to the incapability of making decisions and conveying the wishes. Health care proxy is a solution in such situations.

What is a Health Care Proxy?

Health care proxy is one of the legal documents that allocate a proxy (a person) to monitor and decide the health care issues. Many countries have clauses in the law that allow a person to specify or appoint a person for managing such issues. There are many medical conditions that make a person gradually incapable of doing anything or some time incapable of even communicating with others. In such conditions, if there is no health care proxy is there, it can be of great risk to your life and safety of assets. It would be quite better to appoint some trustworthy person for taking care of your all matters rather than having a court selection for this purpose.

The proxy person has the full rights to make the decision for the person to whom he/she is appointed. He / she can allow or forbid for any treatment as the person himself would do in his/her capacity. The foremost requirement of this agreement is the choice of a sincere and trustworthy person as an agent. In some areas, there are some restrictions regarding the personality of the agent. For example, the doctor who is treating the person cannot be appointed as the proxy. The proxy cannot be financially liable for the decisions made on the behalf of the individual.

A health care proxy must contain the followings:

  • Name and address of agent and alternate agent
  • Time duration for the proxy, the absence of time duration can make it valid forever
  • Necessary instructions according to the will of the person
  • Name and signature of the person along with full address
  • Two legal witnesses

Create your own Health Care Proxy Template by using the following template,

Health Care Proxy

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