A New York medical power of attorney is a written document in which you, the principal, appoint a health care agent. Your agent makes health care decisions on your behalf if you become unable to decide for yourself. New York's statute calls this a health care proxy, and you sign and date it in front of two adult witnesses who also sign.[1]
Last Updated: October 2026. This guide is reviewed and updated regularly to reflect current New York law. If you notice an error or outdated information, please contact us.
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New York power of attorney templates – click for more New York-specific power of attorney documents that you may require.
People also call this document a New York health care proxy, a NY health care proxy or a medical POA. If you need a form that is not specific to New York, see our medical power of attorney form.
New York's rules for this document sit in its health care proxy law. A competent adult may appoint a health care agent by signing and dating a health care proxy in the presence of two adult witnesses. The witnesses must sign the proxy as well.[1] The statute's own words are below.
A competent adult may appoint a health care agent by a health care proxy, signed and dated by the adult in the presence of two adult witnesses who shall also sign the proxy.
The quoted rule asks for the adult's signature, the date and two adult witnesses. FormsPal's template also prints an acknowledgment block on page 7, but the rule above does not mention one.
The statute sets these formalities for the signing:
A health care proxy may not be signed on a form or other writing that also includes the signing of a power of attorney.[1] The rule applies to a proxy executed after the article was enacted. It does not invalidate an earlier delegation of the authority to make health care decisions. Compare the template you plan to use with this rule before you sign.
The statute also covers a remote witness who joins by audio-video conference. If the principal is not personally known to a remote witness, the principal must display valid photographic identification to that witness during the conference. Any remote witness must also receive a legible copy of the proxy, sent by facsimile or electronic means, within twenty-four hours of the principal signing it during the conference.[1]
| Document Name | Medical Power of Attorney Form |
| Name Used in the Statute | Health care proxy |
| State Law | N.Y. Pub. Health Law § 2981 |
| Signing Requirements | Signed and dated by the principal in front of two adult witnesses |
| Who Can't Be the Agent? | Restricted by Section 2981, see below |
| Who Can't Be the Witness? | The agent, see Section 2981 and the list below |
| Avg. Time to Fill Out | 8 minutes |
| # of Fillable Fields | 25 |
| Available Formats | Adobe PDF |
New York limits who may serve as a witness and who may serve as your agent. The person you appoint as agent cannot act as a witness to the signing.[1] The lists below cover the other limits the statute sets.
The FormsPal template has six parts to complete, listed below in the order they appear on the form. Each step names the page of the template where that part sits. Enter your own details in each part, then move on to the next step.
The screenshots under each step show the FormsPal New York medical power of attorney template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.
Under N.Y. Pub. Health Law § 2981(4), your agent's authority starts upon a determination, made under section 2983(1), that you lack capacity to make health care decisions.[1] Under section 2983(1)(a), your attending practitioner makes that determination to a reasonable degree of medical certainty.[2]
After you fill out the form, you still need to sign it and put it to use. Talk with your agent and your family members about your wishes for treatment first, so the person you choose knows what you want. Then follow these steps.
These answers come from the text of New York's health care proxy law. Each one points back to the statute, so you can read the exact wording yourself before you sign anything.
Yes. New York requires two adult witnesses, and they must also sign the proxy.[1]
The adult who appoints the agent signs and dates the document in the presence of the two adult witnesses.[1]
No. The person appointed as agent cannot act as a witness to the signing of the health care proxy.[1]
Yes, for some facilities. The witness rules depend on the kind of facility where the principal lives.
Not if you are a patient or resident of that hospital, or have applied for admission to it. An operator, administrator or employee of a hospital may not be appointed as a health care agent by a person in that position.[1]
Not for a proxy executed after the article was enacted. The health care proxy may not be signed on a form or other writing that also includes the signing of a power of attorney. The rule does not invalidate an earlier delegation of the authority to make health care decisions.[1]
Fill in the free FormsPal template online, print it, or download the PDF, then sign it in front of two adult witnesses.[1] The template card below lets you start right away and keep a copy for your records.
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General information, not legal or tax advice.
