Mass Health Care Proxy

You will need to have two adult witnesses present to watch you sign the document. The Partnership grants permission to 2reproduce this document in its entirety so long as the source including this statement is shown.

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Law Medicine and Ethics Program Deaconess ElderCare Program Hospice Federation of Massachusetts Massachusetts Bar Association Massachusetts Department of Public Health.

Mass health care proxy. The proxy will be instructed to follow in the wishes and desires of the principal. On the first part. MOLST is a medical order form similar to a prescription that.

The Massachusetts Health Care Proxy is a simple legal form that allows you to name someone you trust to make health care decisions for you according to your wishes iffor any reason and at any timeyou become unable to make or communicate those decisions yourself. Learn how to complete a Massachusetts Health Care Proxy form that allows you to choose a person you trust to speak for you if you are unable to speak for yourself. Everything you need to know about the law for patients families and health care providers.

Massachusetts Health Care Proxy with Mental Health Provision Page 6 7. A Massachusetts health care proxy or medical power of attorney allows a principal to appoint a proxy to make health care decisions on their behalf. Instead your health care agent can interpret your wishes as medical circumstances change and can make decisions you could not have known would have to be made.

Medical Society Includes information on health care proxies living wills hospice and more. A health care proxy is a document that allows you to name someone your agent to make health care decisions for you if you are in a situation where you cannot do this for yourself. I have been named by the principal as the principals Health Care Agent in this document.

Health care proxies and end of life care Mass. Model Health Care Proxy form developed by a Task Force of the following organizations. Please check one ___ I am.

Section 7 Revocation of proxy. Whether or not you live in Massachusetts you can use the Health Care Proxy form if you receive your health care in Massachusetts. 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.

Health Care Proxy does not require that you decide in advance decisions that may arise. Get information about the Massachusetts Health Care Proxy a simple legal document that enables a patient to appoint someone they trust to make health care decisions if the patient is unable to do so. You can use the instructions as a checklist as you fill out the form.

MASSACHUSETTS HEALTH CARE PROXY Information Instructions and Form What does the Health Care Proxy Law allow. Follow the step-by-step instructions and sign and date the Health Care Proxy in front of two witnesse s who sign and date the document after you. Brian Cyr RN Gail Alexander RN Jessica Kaloustian SLP and Christine Marmen RN.

Section 4 Contents of proxy. Section 3 Eligibility to serve as agent. This Health Care Proxy Form was prepared by The Central Massachusetts Partnership to Improve Care at the End of Life.

Section 2 Appointment of health care agents. This Health Care Proxy Form was prepared by The Central Massachusetts Partnership to Improve Care at the End of Life. Your health care agent and.

In Massachusetts if a person becomes incapable of making medical decisions eg due to unconsciousness dementia or other mental limitations it is their health care agent who is authorized to make medical decisions for them. Section 5 Authority of agent. The Health Care Proxy form allows you to set limits on what authority your health care agent will have over your health care decisions.

Your Name and Address Required. Massachusetts Health Care Proxy Instructions and Form. 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.

Section 6 Incapacity of patient. To create a valid Massachusetts Health Care Proxy first print this document so you have the instructions and the blank form in front of you. To create your Health Care Proxy print this two page form and place the instructions page and the blank document in front of you.

The Partnership grants permission to reproduce this document in its entirety so long as the source including this statement is shown. You do not need a lawyer. Boston University Schools of Medicine and Public Health.

This online program is free and open to MGH staff patients and the general public. Massachusetts Medical Orders for Life-Sustaining Treatment MOLST Dept. Statement of Health Care Agent and Alternate Optional Health Care Agent.

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