Please rate Ny Health Proxy Form 1430 8-22
Health care agent, optional alternate, your signature and a statement by witnesses.
Agent: Agent's Name, Agent's Home Address and Agent's Telephone Numbers.
Alternate: Optional, if the person appointed is unable, unwilling or unavailable to act as your health care agent.
Expire: Unless revoked, it remains in effect indefinitely or until the date or condition you state.
Witnesses: Witnesses must be 18 years of age or older and cannot be the health care agent or alternate.
Organ donation: Optional section on organ and/or tissue donation.
| Question | Answer |
|---|---|
| Form Name | New York Health Care Proxy |
| Form Length | 8 pages |
| Fillable? | Yes |
| Fillable fields | 31 |
| Avg. time to fill out | 6 min |
| Other names | Health Care Proxy |
| Official source | New York Health Care Proxy, New York State Department of Health |
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Please rate Ny Health Proxy Form 1430 8-22
