New York Health Care Proxy Template

New York Health Care Proxy Template

A New York Health Care Proxy template with completion notes and the blank form. New York adults who want to name a health care agent to make medical decisions if they cannot.

What's included

• Health Care Proxy (7 pages): the statutory health care proxy form in Public Health Law §2981(5)(d), reproduced verbatim, with space for instructions on artificial nutrition and hydration (§2982(2)) and an optional organ donation page (§2981(5)(f)).

Each document starts on its own page with plain-English completion notes, followed by the blank form. Where New York law supplies a form, the statutory wording is reproduced verbatim.

Signing requirements (New York)

• Health Care Proxy: sign and date in front of two adult witnesses, who also sign; the agent may not be a witness (Public Health Law §2981(2)). No notary is required.

File formats

Editable Word (.docx) and print-ready PDF (US Letter) for every document, delivered as a ZIP digital download. Nothing is shipped.

Legal research last verified September 29, 2026.

This is a fill-in template, not legal advice. Laws change; check your state's current requirements before signing.

Licensed to the original purchaser for personal use only; not for resale or redistribution.

Some content in this template was drafted with the help of AI tools and reviewed before listing.