All forms
HealthcarepdfAll States
Healthcare Proxy Designation
Document appointing a trusted person as healthcare agent to make medical decisions on your behalf if you become incapacitated.
PDF TemplateUse the instructions below to complete this form
Instructions
Name your healthcare agent and an alternate agent. Specify any limitations on the agent's authority. The agent's powers activate only when your attending physician determines you lack capacity to make decisions. Sign before two witnesses; some states require notarization. Your agent cannot be your treating physician. Revocation is effective upon oral or written notice to the agent or provider.