A health care proxy is how New York lets you choose the person who will make medical decisions for you if you cannot make them yourself. The person you choose is your health care agent. New York’s version is short, needs no lawyer and no notary, and has one rule that surprises many families: unless your agent reasonably knows your wishes about artificial nutrition and hydration (feeding tubes or IV lines), your agent cannot decide about them at all.
This page explains the New York Health Care Proxy Law item by item, quoting the Department of Health’s official form and the statute, and gives you a free form in PDF and Word.
The short answer
Any competent adult can appoint a health care agent by signing a health care proxy. You sign and date it “in the presence of two adult witnesses who shall also sign the proxy”, and “the person appointed as agent shall not act as witness” (Public Health Law section 2981). In the Department of Health’s words: “You don’t need a lawyer or a notary, just two adult witnesses.” Your agent starts deciding only “when your doctor determines that you are not able to make health care decisions for yourself.”
How to sign a New York health care proxy
| Step | What the official form says |
|---|---|
| You sign and date it | “You must date and sign this Health Care Proxy form. If you are unable to sign yourself, you may direct someone else to sign in your presence. Be sure to include your address.” |
| Two witnesses sign | “Two witnesses 18 years of age or older must sign this Health Care Proxy form.” |
| Who cannot witness | “The person who is appointed your agent or alternate agent cannot sign as a witness.” |
| Notary | Not needed: “You don’t need a lawyer or a notary, just two adult witnesses.” |
| Which form | “You can use the form printed here, but you don’t have to use this form.” |
Each witness signs a short statement that you are “personally known to me”, appear “to be of sound mind and acting of his or her own free will”, and signed “in my presence”. The statute also sets extra witness rules for residents of certain mental hygiene facilities, and allows witnessing by audio-video technology when its conditions are met (section 2981).
Who can be your health care agent
- Any adult. “Anyone 18 years of age or older can be a health care agent”, including a family member or close friend.
- Your doctor, with a catch. “If you select a doctor as your agent, he or she will have to choose between acting as your agent or as your attending doctor because a doctor cannot do both at the same time.”
- Facility staff. “If you are a patient or resident of a hospital, nursing home or mental hygiene facility, there are special restrictions about naming someone who works for that facility as your agent.”
- The ten-principal limit. A person cannot be appointed “if, at the time of appointment, he or she is presently appointed health care agent for ten principals”, unless he or she is your spouse, child, parent, brother, sister or grandparent, or a descendant of, or married to, one of them (section 2981(3)(d)).
- An alternate. You may name an alternate agent to take over if your agent “is unable, unwilling or unavailable to act”.
Talk to the person first. The form’s instructions say: “Before appointing someone as your health care agent, discuss it with him or her to make sure that he or she is willing to act as your agent.” Your agent “cannot be sued for health care decisions made in good faith”, and cannot be held liable for the cost of your care just because they are your agent.
When your agent can act, and when you still decide
Your agent’s authority starts only after your doctor decides you cannot make your own health care decisions. That can be temporary. The Department of Health gives the example of general anesthesia or a coma after an accident, and adds: “When you again become able to make your own health care decisions, your health care agent will no longer be authorized to act.”
Your objection wins. Even after you sign, “you have the right to make health care decisions for yourself as long as you are able to do so, and treatment cannot be given to you or stopped if you object, nor will your agent have any power to object.”
What your agent can decide
Unless you limit it, the form gives your agent “the authority to make all health care decisions for you, including the decision to remove or provide life-sustaining treatment”. “Health care” means “any treatment, service or procedure to diagnose or treat your physical or mental condition.” Hospitals, nursing homes and doctors “are legally required to provide your health care agent with the same information that would be provided to you and to honor the decisions by your agent as if they were made by you.” One caveat: if a hospital or nursing home objects to some treatment options, “they must tell you or your agent BEFORE or upon admission, if reasonably possible.”
Your agent must follow your wishes and your “moral and religious beliefs”. If your wishes are unknown, “your agent is legally required to act in your best interest”, except for artificial nutrition and hydration, where your agent must reasonably know your wishes (see below). A health care proxy does not cover money: it “does not give your agent the power to make non-health care decisions for you, such as financial decisions.”
The feeding tube rule
New York treats artificial nutrition and hydration differently. The form says: “Unless your agent reasonably knows your wishes about artificial nutrition and hydration (nourishment and water provided by a feeding tube or intravenous line), he or she will not be allowed to refuse or consent to those measures for you.” Tell your agent what you want, or write it in item (4) of the form.
Filling in the form, item by item
The Department of Health form (DOH-1430) has seven numbered items:
| Item | What goes there |
|---|---|
| (1) Agent | Your name, then the name, home address and telephone number of your agent. |
| (2) Alternate agent | Optional. Same details for the person who steps in if your agent cannot act. |
| (3) Expiration | Optional. “Your Health Care Proxy will remain valid indefinitely unless you set an expiration date or condition for its expiration.” |
| (4) Instructions and limits | Optional. Your wishes, including about artificial nutrition and hydration. “If you do not state any limitations, your agent will be allowed to make all health care decisions that you could have made, including the decision to consent to or refuse life-sustaining treatment.” |
| (5) Your signature | Print your name, sign, date it and add your address. |
| (6) Organ, eye and tissue donation | Optional. Check any that apply and add limitations, then sign and date this section, and “be sure to have the section witnessed by two people”. |
| (7) Witnesses | Two adults, neither of them your agent or alternate, each with printed name, signature, date and address. |
Sample wording for item (4)
The form’s instructions suggest wording you can adapt. For broad authority:
“I have discussed my wishes with my health care agent and alternate and they know my wishes including those about artificial nutrition and hydration.”
For more specific instructions, the Department of Health offers these openings, each ending with the treatments you do or do not want:
- “If I become terminally ill, I do/don’t want to receive the following types of treatments….”
- “If I am in a coma or have little conscious understanding, with no hope of recovery, then I do/don’t want the following types of treatments:….”
- “If I have brain damage or a brain disease that makes me unable to recognize people or speak and there is no hope that my condition will improve, I do/don’t want the following types of treatments:….”
The form lists examples of treatments you may want to mention: artificial respiration, artificial nutrition and hydration, cardiopulmonary resuscitation (CPR), antipsychotic medication, electric shock therapy, antibiotics, surgical procedures, dialysis, transplantation, blood transfusions, abortion and sterilization. “This is not a complete list.”
Organ, eye and tissue donation
Item (6) lets you make an anatomical gift effective at your death: “Any needed organs, eyes and/or tissues”, or only those you list, with any limitations. Have this section witnessed by two people. Leaving it blank “will not be taken to mean that you do not wish to make a donation”. Since August 26, 2009, your agent can also make decisions after your death, “but only those regarding organ, eye and/or tissue donation.” If you state nothing, New York law sets an order of people who may consent for you, in this order: your health care agent; the agent you designated to control the disposition of your remains; your spouse (if not legally separated) or domestic partner; an adult son or daughter; either parent; an adult brother or sister; an adult grandchild; a grandparent; a guardian appointed by a court before your death; or any other person authorized to dispose of your body.
Health care proxy, living will or power of attorney?
| Document | What it does in New York |
|---|---|
| Health care proxy | Names a person to make health care decisions for you. Your agent “can interpret your wishes as medical circumstances change”. |
| Living will | “A document that provides specific instructions about health care decisions.” You may put such instructions on the proxy form itself. |
| Power of attorney | Covers money and property, not health care. The proxy “shall not be executed on a form or other writing that also includes the execution of a power of attorney” (section 2981(5)). Sign them as two separate documents. |
Changing or cancelling it
- Cancel it. “You may cancel the authority given to your agent by telling him or her or your health care provider orally or in writing.”
- Replace it. To change your agent or your instructions, “Simply fill out a new form.”
- Set an end date. You can make it expire on a date or event in item (3). Otherwise it is “valid indefinitely”.
- Divorce or separation. If your spouse is your agent or alternate and you divorce or legally separate, “the appointment is automatically cancelled”. To keep your former spouse, note it on your current form and date it, or sign a new form naming them.
Where to keep it
The Department of Health suggests giving copies to your agent, your doctor, your attorney and family members or close friends, and keeping one in your wallet or purse, “but not in a location where no one can access it, like a safe deposit box. Bring a copy if you are admitted to the hospital, even for minor surgery, or if you undergo outpatient surgery.”
Common mistakes
- Asking your agent to sign as a witness. Neither the agent nor the alternate may witness.
- Staying silent about feeding tubes. Without known wishes, your agent cannot decide about artificial nutrition and hydration.
- Combining it with a financial power of attorney in one document.
- Naming someone without asking them first, or without giving them a signed copy.
- Locking the only copy in a safe deposit box.
Free NYS health care proxy form (DOH-1430 items) in PDF and Word
Download the form in PDF or Word. It follows the seven items of the Department of Health form DOH-1430, with the witness statement and the optional donation section, plus a one-page checklist of the signing rules. You can also use the Department’s own fillable form, published on the New York State Department of Health website in English and other languages.
New York health care proxy: common questions
Does a New York health care proxy need to be notarized?
No. The Department of Health says: “You don’t need a lawyer or a notary, just two adult witnesses.”
Can a family member witness a health care proxy in New York?
The form bars only your agent and alternate from witnessing, and requires witnesses to be 18 or older. A relative who is not your agent or alternate is not excluded by the form. Extra witness rules apply if you live in certain mental hygiene facilities (section 2981(2)).
Does a New York health care proxy expire?
Not unless you write an expiration date or condition in item (3), or cancel it. Otherwise “the Health Care Proxy will be valid indefinitely.”
Is a health care proxy from another state valid in New York?
Generally yes. Under Public Health Law section 2990, a health care proxy or similar instrument executed in another state “in compliance with the law of that state or jurisdiction shall be considered validly executed”. If you live in New York, signing a New York proxy avoids questions. If you move away, check the rules of your new state.
What happens if I have no health care agent?
The Department of Health says that without an available agent, “health care providers will make health care decisions for you that follow instructions you gave while you were still able to do so”, and that providers “often look to family members for guidance.”
Related
- Medical power of attorney template for other states
- Living will template
- Durable power of attorney for financial decisions
- Texas medical power of attorney, for comparison
How this page was checked
Quotations come from the New York State Department of Health’s Health Care Proxy form and instructions (DOH-1430, revised 8/22) and its health care proxy page, and from Public Health Law sections 2981 (subdivisions 2, 3(d) and 5(e)) and 2990 on the New York State Senate’s official laws site. The downloadable form was compared item by item against DOH-1430.
Last verified: October 2026. We do not advance this date without re-checking the sources. New York can amend the Health Care Proxy Law and the Department of Health can revise its form: check the current versions before you sign.
LegalTemplateVault is not a law firm and does not provide legal advice. Compiled and edited by Daniel Mercer, editor of LegalTemplateVault. He is not an attorney, and neither is anyone else on this site: we compile primary sources and cite them so you can check them yourself.