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ORDER FORM Mass. Health Decisions Publications PO BOX 1407, Apex, NC 27502 (781) 7841966 Email: proxy@masshealthdecisions.org SHIP TO:6. PROFESSIONAL PACKETS Basics Package: 200 Health Care Proxies
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How to fill out order health care proxy

01
Obtain the necessary forms for an order health care proxy.
02
Provide your personal information such as full name, address, and contact information.
03
Choose a trusted individual to act as your health care proxy.
04
Specify the powers and limitations of the health care proxy.
05
Sign and date the form in the presence of witnesses as required by law.
06
Make copies of the completed form and distribute them to your healthcare providers.

Who needs order health care proxy?

01
Anyone who wants to designate a trusted individual to make healthcare decisions on their behalf in case they become unable to do so due to incapacity.
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An order health care proxy is a legal document that allows an individual to appoint another person to make medical decisions on their behalf if they become unable to do so.
Individuals who wish to designate someone to make health care decisions for them in the event of incapacity are required to file an order health care proxy.
To fill out an order health care proxy, you need to complete the required forms, which typically include your personal information, the name of your designated proxy, and any specific health care wishes you want to be followed.
The purpose of an order health care proxy is to ensure that your medical decisions are made according to your preferences when you are unable to communicate or make those decisions yourself.
The order health care proxy must report information such as the appointing individual's name and address, the name and address of the designated proxy, and any specific instructions regarding health care preferences.
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