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Support >  Health Care Proxy

Last update: 05/29/2014


There may come a time when our loved one or dependent is unable to make decisions about receiving medical interventions or tests.  This might come about from loss of consciousness, but also the inability to think clearly or make decisions due to the effects of the medical condition or  treatments.  Our role as primary caregivers is to recognize this need in and act in a timely manner a so that essential medical services are not delayed.  

To assume this role, the caregiver must first receive legal authorization to act on behalf of another.  

"A health care proxy is a power of attorney that allows an person who is authorized to act on behalf of another to make health care decisions in the event that the primary individual is incapable of executing such decisions." 

A step-by step guide on how this might be accomplished follows.

Steps to receive authorization to act on behalf of a dependent

A health care proxy let's you act on behalf of your husband (or dependent) to approve tests or treatment. But most are designed for an unconscious patient. There are ways around that and here they are. 

Follow these steps. (It's simpler than it looks):

  1. Download the health care proxy from the link below and print it out. You are going to make an important change which your husband must initial. it is the form for New York state but It can be used for all states. It calls for two witnesses. Few states require two witnesses. 

  2. Check here to see if your state requires two witnesses: 

    Even if your state does not require a notary or witness, you want them because you are asking to make your husband's decisions even though the doctor seems to think your husband is able to make his own. It is advisable to get a notary AND a separate witness (any person over with picture ID will do) to witness your husband initialing the change and signing this document. 

  3. If your state does not require two witnesses, use one, but get one. 

    Only four states require a notary but this is not about minimum requirements, it is about making this a strong, effective document the doctor will honor.

    If your dependent is in hospital, social services can arrange a notary. If he is at home, check your yellow pages for a notary. 

  4. Call the notary and briefly explain your dependent  is seriously ill and for an additional fee would they kindly come to your home. 

  5. Have the notary witness your husband initialing your handwritten change to the document and his signature. 

  6. Have your husband's picture ID handy when the notary comes. Have a witness present as well to add their signature. The need to have their photo ID to show the notary as well. 

  7. Download the Health Care Proxy and Power of Attorney here: 

    If you do not have Adobe Reader to open this file, you can download it here:  

    Download Your State's Advance Directives - (scroll down to states)

  8. CROSS OUT THE LAST LINE OF SECTION 1, the section that starts:" I, _____(your husband's name), hereby appoint _____ (your name). " 

    The last line, which reads:

    "This proxy takes effect only when and if I become unable to make my own health care decisions." 

    should be crossed out and write this one beneath it: 


    "As I do not feel able to make or communicate my own health care decisions at this time, this proxy is to take effect immediately, on this date, February XX,=2

    I have full faith and confidence in my wife (husband/daughter), ______(your name here), to make any and all decisions on my behalf." Be sure and have your husband and the witness initial this very important change.

  9. Again, I stress that even if your state does not require it (and only CO, MO, West VA and NC do) that you get this notarized and witnessed. 

    Not all states require a witness, but your aim is to make this document unassailable in case the doctor balks. the New York State form has signature lines for two witnesses. Unless your state also requires two witnesses, one will do. 

    You need an alternate agent in case something happens to you, God forbid. 

    It would be better if this person is not also the witness. 


  10. Be calm and reassuring when you ask you husband to sign this and tell him that this will take the burden off of him and make it easier for you to get him the care he needs. 

    More on how to be calm and other ideas in new posts.

    Prayers and earnest good wishes,

NOTE:  We offer the above as a template or starting point, which we expect will be helpful, while noting and underscoring the limitations of our background in legal matters.  Please also inquire with your medical provider regarding services that may be available to you at the center to help with these and related matters.


See also: 

Advance Directives: Five Wishes: 

Five Wishes lets your family and doctors know:

bullet Who you want to make health care decisions for you when you can't make them.
bullet The kind of medical treatment you want or don't want.
bullet How comfortable you want to be.
bullet How you want people to treat you.
bullet What you want your loved ones to know.

Link to PDF



Disclaimer:  The information on is not intended to be a substitute for 
professional medical advice or to replace your relationship with a physician.
For all medical concerns, you should always consult your doctor. 
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