How do I resign as a healthcare proxy?

There is no formal procedure for retiring as someone's health care proxy. You simply decline to accept the responsibility when the time comes.

Does a healthcare proxy have to be notarized in NY?

All competent adults, 18 years of age or older, can appoint a health care agent by signing a form called a Health Care Proxy. You don't need a lawyer or a notary, just two adult witnesses. Your agent cannot sign as a witness. You can use the form printed here, but you don't have to use this form.

How do I resign as a health care power of attorney?

To resign, you can simply write up a document titled "Resignation" saying "I hereby resign as Agent under the Medical Power...

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New York Revocation of Health Care Proxy

New York Revocation of Health Care Proxy

Name: New York Revocation of Health Care Proxy
Brand: US Legal Forms
Price: 59.00 USD
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Category:

Power of Attorney - Healthcare - Revocations

State:

New York

Control #:

NY-P020B

Format:

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Description Ny Health Care Proxy Form Printable

This form is a revocation of the health care proxy provided in Form NY-P020.

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How to fill out Ny Health Care Proxy Printable?

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Health Care Proxy Form Other Form Names

Care Proxy Form Care Proxy Form New York Proxy Form New York Health Proxy Form Ny Health Proxy Form Blank Health Care Proxy Form Sample Ny Care Proxy Form

Care Proxy Form Pdf FAQ

There is no formal procedure for retiring as someone's health care proxy. You simply decline to accept the responsibility when the time comes.

All competent adults, 18 years of age or older, can appoint a health care agent by signing a form called a Health Care Proxy. You don't need a lawyer or a notary, just two adult witnesses. Your agent cannot sign as a witness. You can use the form printed here, but you don't have to use this form.

Short answer, no. But, be careful. If the proxy (agent under power of attorney or some other form of state law created proxy) signs in their own name for services, they could accidentally make themself liable.

Additionally, it is important to know that you may change your proxy at any time. To do so, create a new health care proxy document. If you regain the ability to make your own decisions, you can choose to speak on your own behalf again.

In your role as Health Care Proxy, you will have the right to make the following types of decisions: Choices about medical care, including medical tests, medicine, or surgery.The option to take legal action on the person's behalf in order to advocate for his or her health care rights and wishes.

In the field of medicine, a healthcare proxy (commonly referred to as HCP) is a document (legal instrument) with which a patient (primary individual) appoints an agent to legally make healthcare decisions on behalf of the patient, when the patient is incapable of making and executing the healthcare decisions stipulated

To resign, you can simply write up a document titled "Resignation" saying "I hereby resign as Agent under the Medical Power...

Ny Health Care Proxy Fillable Trusted and secure by over 3 million people of the world’s leading companies

Revocation of Health Care Proxy

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE NEW YORK CONSOLIDATED LAWS

REVOCATION OF HEALTH CARE PROXY

(Chapter 45, Article 29-C, Â§Â§ 2980 through 2994)

Selected Definitions

An "adult" is any person who is eighteen years of age or older, or is the parent of a child, or has married.

An "attending physician" is the physician, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient.

"Capacity to make health care decisions" is the ability to understand and appreciate the nature and consequences of health care decisions, including the benefits and risks of and alternatives to any proposed health care, and to reach an informed decision.

"Health care" is any treatment, service or procedure to diagnose or treat an individual's physical or mental condition.

A "health care agent" or "agent" is an adult to whom authority to make health care decisions is delegated under a health care proxy.

A "health care decision" is any decision to consent or refuse to consent to health care.

A "health care proxy" is a document delegating the authority to make health care decisions, executed in accordance with the statutory requirements.

"Mental illness" is a mental illness as defined in subdivision twenty, Â§ 1.03 Mental Hyg. of the mental hygiene law. Provided, however, that mental illness does not include dementia, such as alzheimer's disease or other disorders related to dementia.

A "principal" is a person who has executed a health care proxy.

Appointment of Agent

A competent adult may appoint a health care agent in accordance with the statutory requirements.

An adult is presumed competent to appoint a health care agent unless:

such person has been adjudged incompetent or otherwise adjudged not competent to appoint a health care agent; or

unless a committee or guardian of the person has been appointed for the adult pursuant to article seventy-eight of the mental hygiene law or article seventeen-A of the surrogate's court procedure act.

Execution and Witnesses

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. The witnesses must also sign the proxy.

Another person may sign and date the health care proxy for the adult if the adult is unable to do so, at the adult's direction and in the adult's presence, and in the presence of two adult witnesses who must also sign the proxy.

The witnesses must state that the principal appeared to execute the proxy willingly and free from duress.

The person appointed as agent shall not act as witness to execution of the health care proxy.

If a person resides in a mental hygiene facility operated or licensed by the office of mental health, at least one witness must be an individual who is not affiliated with the facility and, if the mental hygiene facility is also a hospital as defined in subdivision ten of Â§ 1.03 Mental Hyg. of the mental hygiene law, at least one witness shall be a qualified psychiatrist.

If a person resides in a mental hygiene facility operated or licensed by the office of mental retardation and developmental disabilities,

at least one witness must be an individual who is not affiliated with the facility and

at least one witness shall be a physician or clinical psychologist who is either

employed by a school named in section 13.17 Mental Hyg. of the mental hygiene law or

who has been employed for a minimum of two years to render care and service in a facility operated or licensed by the office of mental retardation and developmental disabilities, or

who has been approved by the commissioner of mental retardation and developmental disabilities in accordance with regulations approved by the commissioner.

Restrictions and Limitations on a Health Care Agent.

An operator, administrator or employee of a hospital may not be appointed as a health care agent by any person who, at the time of the appointment, is a patient or resident of, or has applied for admission to, such hospital. This restriction does not apply to:

an operator, administrator or employee of a hospital who is related to the principal by blood, marriage or adoption; or

a physician (subject to the limitation set forth below), except that no physician affiliated with a mental hygiene facility or a psychiatric unit of a general hospital may serve as agent for a principal residing in or being treated by such facility or unit unless the physician is related to the principal by blood, marriage or adoption.

If a physician is appointed agent, the physician shall not act as the patient's attending physician after the authority under the health care proxy commences.

No person who is not the spouse, child, parent, brother, sister or grandparent of the principal, or is the issue of, or married to such person, shall be appointed as a health care agent if, at the time of appointment, he or she is presently appointed health care agent for ten principals.

Form

The statutory form is not required. However, any health care proxy must:

identify the principal and agent; and

indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf.

A health care proxy may

include the principal's wishes or instructions about health care decisions, and limitations upon the agent's authority;

provide that it expires upon a specified date or upon the occurrence of a certain condition. If no such date or condition is set forth in the proxy, the proxy shall remain in effect until revoked.

If, prior to the expiration of a proxy, the authority of the agent has commenced, the proxy shall not expire while the principal lacks capacity.

A health care proxy cannot be executed on a form or other writing that also includes the execution of a power of attorney.

Agent's Authority

An agent's authority commences upon a determination that the principal lacks capacity to make health care decisions.

Alternate Agent

A competent adult may designate an alternate agent in the health care proxy to serve in place of the agent when the attending physician has determined in a writing signed by the physician that:

the person appointed as agent is not reasonably available, willing and competent to serve as agent, and

that such person is not expected to become reasonably available, willing and competent to make a timely decision given the patient's medical circumstances.

An agent may be disqualified from acting on the principal's behalf pursuant to statutory provisions or under conditions set forth in the proxy.

If, after an alternate agent's authority commences, the person appointed as the initial agent becomes available, willing and competent to serve as agent:

the authority of the alternate agent shall cease and the authority of the agent shall commence; and

the attending physician shall record the change in agent and the reasons therefor in the principal's medical record.

Obligations and Rights of Agent

Subject to any express limitations in the health care proxy, an agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make.

After consultation with a licensed physician, registered nurse, licensed clinical psychologist or certified social worker, an agent shall make health care decisions:

in accordance with the principal's wishes, including the principal's religious and moral beliefs; or

if the principal's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the principal's best interests; provided, however, that if the principal's wishes regarding the administration of artificial nutrition and hydration are not reasonably known and cannot with reasonable diligence be ascertained, the agent shall not have the authority to make decisions regarding these measures.

An agent has the right to receive medical information and medical and clinical records necessary to make informed decisions regarding the principal's health care.

Revocation

A competent adult may revoke a health care proxy by notifying the agent or a health care provider orally or in writing or by any other act evidencing a specific intent to revoke the proxy.

A health care proxy may be revoked upon execution by the principal of a subsequent health care proxy.

The appointment of the principal's spouse as health care agent is automatically revoked upon the divorce or legal separation of the principal and spouse, unless the principal specifies otherwise.

A physician who is informed of or provided with a revocation of a health care proxy must immediately record the revocation in the principal's medical record and notify the agent and the medical staff responsible for the principal's care of the revocation.

Revocation of Health Care Proxy

STATUTORY REFERENCE

ALL REFERENCES ARE TO THE NEW YORK CONSOLIDATED LAWS

REVOCATION OF HEALTH CARE PROXY

(Chapter 45, Article 29-C, Â§Â§ 2980 through 2994)

Selected Definitions

An "adult" is any person who is eighteen years of age or older, or is the parent of a child, or has married.

An "attending physician" is the physician, selected by or assigned to a patient, who has primary responsibility for the treatment and care of the patient.

"Health care" is any treatment, service or procedure to diagnose or treat an individual's physical or mental condition.

A "health care agent" or "agent" is an adult to whom authority to make health care decisions is delegated under a health care proxy.

A "health care decision" is any decision to consent or refuse to consent to health care.

A "health care proxy" is a document delegating the authority to make health care decisions, executed in accordance with the statutory requirements.

A "principal" is a person who has executed a health care proxy.

Appointment of Agent

A competent adult may appoint a health care agent in accordance with the statutory requirements.

An adult is presumed competent to appoint a health care agent unless:

such person has been adjudged incompetent or otherwise adjudged not competent to appoint a health care agent; or

unless a committee or guardian of the person has been appointed for the adult pursuant to article seventy-eight of the mental hygiene law or article seventeen-A of the surrogate's court procedure act.

Execution and Witnesses

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. The witnesses must also sign the proxy.

The witnesses must state that the principal appeared to execute the proxy willingly and free from duress.

The person appointed as agent shall not act as witness to execution of the health care proxy.

If a person resides in a mental hygiene facility operated or licensed by the office of mental retardation and developmental disabilities,

at least one witness must be an individual who is not affiliated with the facility and

at least one witness shall be a physician or clinical psychologist who is either

employed by a school named in section 13.17 Mental Hyg. of the mental hygiene law or

who has been employed for a minimum of two years to render care and service in a facility operated or licensed by the office of mental retardation and developmental disabilities, or

who has been approved by the commissioner of mental retardation and developmental disabilities in accordance with regulations approved by the commissioner.

Restrictions and Limitations on a Health Care Agent.

an operator, administrator or employee of a hospital who is related to the principal by blood, marriage or adoption; or

a physician (subject to the limitation set forth below), except that no physician affiliated with a mental hygiene facility or a psychiatric unit of a general hospital may serve as agent for a principal residing in or being treated by such facility or unit unless the physician is related to the principal by blood, marriage or adoption.

If a physician is appointed agent, the physician shall not act as the patient's attending physician after the authority under the health care proxy commences.

Form

The statutory form is not required. However, any health care proxy must:

identify the principal and agent; and

indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf.

A health care proxy may

include the principal's wishes or instructions about health care decisions, and limitations upon the agent's authority;

provide that it expires upon a specified date or upon the occurrence of a certain condition. If no such date or condition is set forth in the proxy, the proxy shall remain in effect until revoked.

If, prior to the expiration of a proxy, the authority of the agent has commenced, the proxy shall not expire while the principal lacks capacity.

A health care proxy cannot be executed on a form or other writing that also includes the execution of a power of attorney.

Agent's Authority

An agent's authority commences upon a determination that the principal lacks capacity to make health care decisions.

Alternate Agent

A competent adult may designate an alternate agent in the health care proxy to serve in place of the agent when the attending physician has determined in a writing signed by the physician that:

the person appointed as agent is not reasonably available, willing and competent to serve as agent, and

that such person is not expected to become reasonably available, willing and competent to make a timely decision given the patient's medical circumstances.

An agent may be disqualified from acting on the principal's behalf pursuant to statutory provisions or under conditions set forth in the proxy.

If, after an alternate agent's authority commences, the person appointed as the initial agent becomes available, willing and competent to serve as agent:

the authority of the alternate agent shall cease and the authority of the agent shall commence; and

the attending physician shall record the change in agent and the reasons therefor in the principal's medical record.

Obligations and Rights of Agent

Subject to any express limitations in the health care proxy, an agent has the authority to make any and all health care decisions on the principal's behalf that the principal could make.

After consultation with a licensed physician, registered nurse, licensed clinical psychologist or certified social worker, an agent shall make health care decisions:

in accordance with the principal's wishes, including the principal's religious and moral beliefs; or

if the principal's wishes are not reasonably known and cannot with reasonable diligence be ascertained, in accordance with the principal's best interests; provided, however, that if the principal's wishes regarding the administration of artificial nutrition and hydration are not reasonably known and cannot with reasonable diligence be ascertained, the agent shall not have the authority to make decisions regarding these measures.

An agent has the right to receive medical information and medical and clinical records necessary to make informed decisions regarding the principal's health care.

Revocation

A competent adult may revoke a health care proxy by notifying the agent or a health care provider orally or in writing or by any other act evidencing a specific intent to revoke the proxy.

A health care proxy may be revoked upon execution by the principal of a subsequent health care proxy.

The appointment of the principal's spouse as health care agent is automatically revoked upon the divorce or legal separation of the principal and spouse, unless the principal specifies otherwise.

New York Revocation of Health Care Proxy

Description Ny Health Care Proxy Form Printable

Health Care Proxy Form Printable Related forms

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How to fill out Ny Health Care Proxy Printable?

New York Health Care Proxy Form Printable Form popularity

Health Care Proxy Form Other Form Names

Care Proxy Form Pdf FAQ

How do I resign as a healthcare proxy?

Does a healthcare proxy have to be notarized in NY?

Is a healthcare proxy responsible for bills?

Can a healthcare proxy be changed?

What rights does a healthcare proxy have?

Is a healthcare proxy a legal document?

How do I resign as a health care power of attorney?

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