New York Medical Power of Attorney (POA) Form

No one is ever safe from a medical emergency, and you need to know where to refer to in case any unforeseen situation occurs. In the state of New York, you can use the Health Care Proxy Form, shortly known as the Medical POA form. The document does not discriminate against any category of US citizens: all adults without any exceptions can use this form in case of a medical emergency regardless of their age, social or medical status.

The person initiating the medical power of attorney form conclusion is called a principal. And here, two scenarios are more likely to happen. The principal can be conscious and capable of making an informed decision or not. In the first case, the principal is the one responsible for the paperwork. While in the second case, if the patient cannot decide on anything, the authorities assign an attorney to defend the principal’s rights. Cases of the principal being recognized as incapacitated mary vary depending on their reason: a patient may be in a coma, severely injured, or have a mental condition that does not allow them to make independent and reasonable decisions. Thus, the attorney will be making all healthcare-related decisions on behalf of the patient. That is a very important task to fulfill.

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As it is a very serious legal form, at least two witnesses must sign the New York Health Care Proxy Form to prove that it is valid. Only after the signing procedure, the document may obtain legal force in the state. If the patient has a condition that deprives them of legal capacity, and it has been for a while now, you must properly choose a legal representative beforehand, so that they could keep an eye on the principal and take care of all the paperwork at all times. Another important condition: the principal should trust the assigned attorney completely, as the principal’s health and life will be in their hands.

New York Laws and Requirements

You may find all related info on the New York Medical POA in Article 29-C–2980(8), along with the form definition, local norms, and restrictions. As we have already mentioned above, the form must be authorized by two witnesses who are 18 years or older at the moment of signing. It is an obligatory rule. If the principal or the responsible attorney fails to provide the witnesses, the form will be considered invalid automatically. The paper, however, does not require state notarization.

Another important detail to mention before we proceed to the next section: if the attorney is taking care of the principal’s business, they should get to keep the original version of the document and all supporting papers (if applicable). Respective medical services might require those, so the responsible keeper shall have them when the push comes to shove.

New York Medical Power of Attorney Form Details

Document Name New York Medical Power of Attorney Form
State Form Name New York Health Care Proxy
State Laws New York Consolidated Laws, Sections 2980 to 2994
Signing Requirements Two Witnesses
Who Can’t Be the Agent? Section 2981(3)
Who Can’t Be the Witness? Section 2981(2)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Steps to Fill Out the Form

In the first section of your review, we have told you everything you need to know about the New York Health Care Proxy. Here, we will give some specific recommendations on how to fill it out properly. Plus, we encourage you to use our latest software tools and developments to create and customize the legal form you need.

1. Create the Form Template

You may download the current version of the Form from the official state Healthcare website and fill it in manually. But, with form-building software, you can type the data in and edit the form online. You are free to choose either format that suits you most.

2. Indicate the Principal (or the Attorney)

First and foremost, you need to indicate the identity of the respective patient. Again, if the assigned attorney represents the principal and acts in their best interest, you still need to provide info on the patient but also indicate the attorney’s personality. The procedure is quite simple: provide the parties full legal names and relevant contact information, including the emergency contact. Physical address is required as well.

Principal and attorney indication part of New York mpoa template

3. Indicate Optional Solutions

After you identify the principal and attorney, you need to appoint an alternate attorney in case the first attorney is unable to make health decisions for the principal. You also need to determine the date from which the attorney will be eligible to use their authority. If you want the attorney to have the credentials to use their powers from the moment of signing the form, you need to identify this in this part. If you want the attorney to have the credentials to use their authority only if you are found incapacitated, you must also identify this in this part.

Optional solutions indication section of a medical power of attorney for New York

4. Limit the Attorney’s Powers

In this section of the document, you can limit the powers of the attorney if you have such a need. Even if you have previously discussed with the attorney the procedure for conducting healthcare procedures in certain cases, it is better to repeat and list all your wishes and limit the attorney’s powers in this section of the document.

Powers limitation section of a New York medical power of attorney form

5. Indicate Your Wish on Organ Donation

Here you need to indicate whether you are ready to donate organs after your death. If you are ready to donate any organs, you need to put your initials in front of this statement. If you are ready to donate some organs, you need to list all the organs that you are ready to donate. If you have special instructions regarding the donation of your organs after death, you need to check all the special instructions and instructions in the column specially allocated for this.

Part for wishes regarding organ donation of mpoa document for New York

6. Provide Date and Signature

Once you (or the responsible legal representative in the framework of their delegated authority) have read through the document and have agreed on the conditions and information accuracy, you (or the representative) may put the current date and signature.

The attorney and witness must also fill in their full legal names and contact info and put the signatures.

Signing part of New York medical power of attorney form

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Published: Nov 19, 2020