Health Care Proxy Form Ma

Massachusetts Health Care Proxy – Brigham and Women’s …

Your Agent will make decisions about your health care only when you are, for some reason, unable to do that yourself. This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions.
Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions. Your doctor will tell you of this if there is any sign that you would understand it.
Acting with your authority, your Agent can make any health care decision that you could, if you were able. If you give your Agent full authority to act for you, he or she can consent to or refuse any medical treatment, including treatment that could keep you alive.
Your Agent will make decisions for you only after talking with your doctor or health care provider, and after fully considering all the option regarding diagnosis, prognosis and treatment of your illness or condition. Your Agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you.
Your Agent will make health care decisions for you according to your wishes or according to his/her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your agent. It is very important that you talk with your Agent so that he or she knows what is important to you. If your Agent does not know what your wishes would be in a particular situation, your Agent will decide based on what he or she thinks would be in your best interests. After your doctor has determined that you lack the ability to make health care decisions, if you still object to any decision made by your Agent, your own decisions will be honored unless a Court determines that you lack capacity to make health care decisions.
Your Agent’s decisions will have the same authority as yours would, if you were able, and will be honored over those of any other person, except for nay limitation you yourself made, or except for a Court Order specifically overriding the Proxy.
How to create a health care proxy

How to create a health care proxy

Who would you pick to make medical decisions for you if you were no longer able to make them on your own? That’s the question answered by a health care proxy, also known as a durable power of attorney for health care or a medical power of attorney. Your health care proxy has the power to consult with doctors, review your medical records, and make important decisions about your medical treatment.
And a proxy might be more important than you realize: A 2014 study found that nearly 50 percent of adults age 65 and older required at least some involvement from a family member or another surrogate decision-maker within 48 hours of being hospitalized. So it’s important both that you create a health care proxy and that you select someone you trust, whether that’s a close friend or family member.
If you don’t name a proxy yourself, you run the risk of your loved ones struggling over who has the right to make medical decisions for you in a crisis—or having someone you don’t want making those decisions.
A health care proxy (also known as an agent or surrogate) can make choices about your medical care, including tests, medications and surgeries—but only if you’re unable to speak for yourself. They can authorize or refuse tests and treatments, pain management assistance, and even life-support procedures. They can also choose which hospital, medical facility, nursing home, or hospice center you move to for your care.
In order to help inform those decisions, a proxy has access to your medical history or charts and can approve the release of your medical records to other providers. And when it comes to covering the expense of your care, they can take legal action on your behalf and apply for Medicare, Medicaid, or other programs or insurance benefits on your behalf. (However, you should also have a separate durable power of attorney document in place appointing someone to handle your legal and financial affairs more broadly. )
How to choose your health care proxy
A health care proxy can play a vital role in your care, if needed. It’s crucial that the person be someone you trust to access your sensitive medical information and to understand what’s important to you.
A health care proxy can be any adult—a spouse, sibling, relative, or even close friend—but you should take care to select someone whose emotional connection to you won’t impact their decision to act in your best interests. For example, if you feel strongly that you wouldn’t want to stay on life support indefinitely, but know your sister would struggle to follow through with your choice in a crisis, she may not be the best person for the role.
One important part of establishing a health care proxy is getting that person up to date on your current health and wishes—before a crisis hits. That means selecting someone who you’ll be comfortable talking with about your medical history, including current health conditions and symptoms. They’ll also need an understanding of what medical treatments you want and don’t want, in the event they have to take over the decision-making.
Beyond those factors, consider that your health care proxy should ideally have good communication skills (to be able to relay your wishes to doctors) and take their commitment as your proxy seriously.
Make it official
Forms to select a health care proxy vary from state to state, so you’ll need to ensure that you’ve carefully completed the relevant form. In some states, naming a health care proxy is one part of a larger living will or advance directive. In those cases, you can indicate the person you name as your health care proxy as part of the living will form. Five Wishes is a straightforward advance directive that works in 42 states, and the site walks you through the entire process in plain language. For $5 you can order a printed copy or fill it out online. Or find your state’s official forms here:
After you’ve filled out the document, you’ll need two adults (not including your health care proxy) to also sign the form. You do not need a lawyer to create a health care proxy; just make sure the form is signed and witnessed according to the directions on the form.
Give copies to your health care providers, health care proxy, spouse, and any close friends who you think might be involved in your care. You should also be sure to carry a copy on your person, whether that means tucking it into your wallet or purse, so medical professionals know who to contact in case of emergency.
By Kate Rockwood
The Massachusetts Health Care Proxy Form

The Massachusetts Health Care Proxy Form

The purpose and use of MOLST is very different from the use of a Health Care Proxy.
Important Information about Health Care Proxy forms in Massachusetts:
To plan for the future possibility of accidents or illness, all adults (aged 18 and older) should use a health care proxy form to appoint their health care agent.
In Massachusetts, if a person becomes incapable of making medical decisions (e. g., due to unconsciousness, dementia or other mental limitations), it is their “health care agent” who is authorized to make medical decisions for them. It cannot be assumed that a family member or friend will be authorized to make medical decisions in every situation or setting.
How to appoint your health care agent:
Choose someone you trust the most to:
Act on your behalf in the future if you become unable to make decisions yourself
Listen to and understand your values, goals and wishes about medical care
Agree to make the decisions you would want – not necessarily what they want
Print a Health Care Proxy form (See a Health Care Proxy form in Spanish)
Complete and sign the form
Ask two other people to sign the form as witnesses
Put the form where it is easy to find
Give a copy of your health care proxy form to your health care agent
Remember to talk about your medical care preferences with your health care agent

Frequently Asked Questions about health care proxy form ma

Does a healthcare proxy need to be notarized in Massachusetts?

The person you appoint as your proxy cannot serve as a witness. You do not need to notarize your Massachusetts healthcare proxy.

What is health care proxy in MA?

Frequently Asked Questions About the Massachusetts Health Care Proxy. … The Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions.

How do I fill out a Massachusetts healthcare proxy?

How do I fill out the form? At the top of the form, print your full name and address. Print the name, address, and phone number of the person you choose as your Health Care Agent. (Optional: If you think your Agent might not be available at any future time, you may name a second person as an Alternate Agent.

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