Health Care Proxy

How to Choose a Health Care Proxy

What type of health care would you want if you became too sick to let your providers know? With advance care planning, you can stay in control and make sure your wishes are known and valued.

The Health Care Proxy is a simple document, legally valid in Massachusetts, that allows you to name someone (an "agent") to make health care decisions on your behalf if you are unable to make or communicate those decisions. 

Health Care Proxy Documents

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Please print and fill out all fields in the proxy form by hand. The patient must sign the form, along with two witnesses. The witnesses cannot be the health care agent or alternate agent. You do not need a notary or a lawyer to complete this form. Once finished, bring it to your provider’s office to add to your medical record, or upload it to your myChart portal.