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Andrew D. Pearl, MD Orthopedic Surgery & Sports Medicine 535 East 70th Street New York, NY 10021 Tel (212) 7742878 Fax (212) 7742798 www.andrewpearle.comHEALTHCARE PROXY, patient ___, dateofbirth
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How to fill out healthcare proxy
How to fill out healthcare proxy
01
Discuss your wishes with your chosen healthcare proxy.
02
Obtain the necessary healthcare proxy form from your state or healthcare provider.
03
Fill out the form with your personal information and the name of your chosen proxy.
04
Specify your medical wishes and preferences on the form.
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 and loved ones.
Who needs healthcare proxy?
01
Anyone over the age of 18 should consider having a healthcare proxy in place.
02
Individuals with chronic illnesses or medical conditions that may require decisions to be made on their behalf.
03
Elderly individuals who may need assistance with medical decisions in the future.
04
Anyone who wants to ensure that their wishes are honored in the event they are unable to communicate their preferences.
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What is healthcare proxy?
A healthcare proxy is a legal document that allows an individual to appoint someone to make medical decisions on their behalf if they are unable to do so.
Who is required to file healthcare proxy?
Anyone who wants to ensure that their healthcare wishes are followed in case they become incapacitated is encouraged to file a healthcare proxy.
How to fill out healthcare proxy?
To fill out a healthcare proxy, an individual must designate a trusted person as their healthcare agent, discuss their medical preferences and wishes with the agent, and sign the document in the presence of witnesses.
What is the purpose of healthcare proxy?
The purpose of a healthcare proxy is to ensure that an individual's medical wishes are known and respected if they are unable to communicate them themselves.
What information must be reported on healthcare proxy?
The healthcare proxy should include the name and contact information of the healthcare agent, specific medical decisions the agent is authorized to make, and any additional instructions or preferences.
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