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New York · Reviewed source record · No account

Your New York healthcare proxy worksheet

Prepare names and contact details privately in this browser, then transfer them to the state-published form. This worksheet is not a legal document and should not be signed.

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Direct answer · reviewed record NY

Which form does New York use?

New York calls this document the Health Care Proxy. New York State Department of Health publishes this agency form for appointing a health care agent.

Signing summary: Sign in front of two witnesses who are at least 18 years old. The Department of Health form instructs two witnesses and does not provide a notary alternative.

Open the state-published form(opens in a new tab)Check the authority page(opens in a new tab)

Source & freshness ledger

What was checked

This static page was checked on the source and editorial review dates shown. The build blocks an overdue record from future publication, but a deployed copy cannot remove itself. Always confirm the current instructions on the issuing authority's site before signing.

Publication status
Reviewed for publication
Issuing authority
New York State Department of Health: Choosing Your Health Care Agent
Form reviewed
Health Care Proxy Form · No version date stated on the reviewed form
Source checked
Editorial review
by MedicalRecords.com Editorial
Review due
Review owner
MedicalRecords.com Editorial Operations

Execution details captured from the reviewed form

Witnesses
Sign in front of two witnesses who are at least 18 years old.
  • The person appointed as agent cannot be a witness.
  • The person appointed as alternate agent cannot be a witness.
Notary
The Department of Health form instructs two witnesses and does not provide a notary alternative.
Special facility rule
No separate special-facility witness instruction appears in the reviewed form.
Choose the official formStep 1 of 4
  1. Authority
  2. Signer
  3. Principal
  4. Advocate

Start with the governing form

Free, no account, no payment. We only continue when the official state form has passed source review.

Which state form do you need?

Each available path is tied to one reviewed government source record.

In New York, the reviewed document is the Health Care Proxy.

Signing summary: Sign in front of two witnesses who are at least 18 years old. The Department of Health form instructs two witnesses and does not provide a notary alternative.

Official source checked August 11, 2026

Open the New York State Department of Health form

Unavailable states stay blocked until their official form and signing rules complete review.