The Healthcare Proxy Form is recognized by all 50 states. Some states use different names such as Healthcare Agent, Healthcare Representative, and Healthcare Power of Attorney. While these forms were obtained from a major hospital, it is your responsibility to ensure that the free healthcare proxy will be accepted by the hospital or healthcare providers with which you entrust your medical care. Many states will not accept a healthcare proxy if it was signed in another state.

A healthcare proxy is a legal document that permits you to designate another person or persons as your health care representative to make healthcare decisions on your behalf if you are no longer physically or mentally able to do so. You allow your healthcare agent the legal authority to make medical decisions for you if you are unable to speak for yourself.

Unless otherwise stated in the proxy form, the healthcare proxy becomes effective only when you are unable to make decisions for yourself, as determined by a physician. Until that time, you can make your own healthcare decisions. The healthcare proxy can be terminated orally, and you have the right to sign a new one if you are physically and mentally able to do so at the time of the signing.

Example of Healthcare Proxy Form

We offer the completely free Healthcare Proxy in PDF format only. If you would like the document in Microsoft Word or any other format, you can convert it using an appropriate document editing program.

Frequently Asked Questions

Printable Healthcare Proxy Forms By State

Select the appropriate file to download the Free Healthcare Proxy Form for the state in which it will be signed. If you intend to move after signing the proxy form, be sure to check with the state to which you are moving. You might need to sign a new form in that state.

Printable Alabama Healthcare Proxy Form

Printable Alaska Healthcare Proxy Form

Printable Arizona Healthcare Proxy Form

Printable Arkansas Healthcare Proxy Form

Printable California Healthcare Proxy Form

Printable Colorado Healthcare Proxy Form

Printable Connecticut Healthcare Proxy Form

Printable Delaware Healthcare Proxy Form

Printable Florida Healthcare Proxy Form

Printable Georgia Healthcare Proxy Form

Printable Hawaii Healthcare Proxy Form

Printable Idaho Healthcare Proxy Form

Printable Illinois Healthcare Proxy Form

Printable Indiana Healthcare Proxy Form

Printable Iowa Healthcare Proxy Form

Printable Kansas Healthcare Proxy Form

Printable Kentucky Healthcare Proxy Form

Printable Louisiana Healthcare Proxy Form

Printable Maine Healthcare Proxy Form

Printable Maryland Healthcare Proxy Form

Printable Massachusetts Healthcare Proxy Form

Printable Michigan Healthcare Proxy Form

Printable Minnesota Healthcare Proxy Form

Printable Mississippi Healthcare Proxy Form

Printable Missouri Healthcare Proxy Form

Printable Montana Healthcare Proxy Form

Printable Nebraska Healthcare Proxy Form

Printable Nevada Healthcare Proxy Form

Printable New Hampshire Healthcare Proxy Form

Printable New Jersey Healthcare Proxy Form

Printable New Mexico Healthcare Proxy Form

Printable New York Healthcare Proxy Form

Printable North Carolina Healthcare Proxy Form

Printable North Dakota Healthcare Proxy Form

Printable Ohio Healthcare Proxy Form

Printable Oklahoma Healthcare Proxy Form

Printable Oregon Healthcare Proxy Form

Printable Pennsylvania Healthcare Proxy Form

Printable Rhode Island Healthcare Proxy Form

Printable South Carolina Healthcare Proxy Form

Printable South Dakota Healthcare Proxy Form

Printable Tennessee Healthcare Proxy Form

Printable Texas Healthcare Proxy Form

Printable Utah Healthcare Proxy Form

Printable Vermont Healthcare Proxy Form

Printable Virginia Healthcare Proxy Form

Printable Washington Healthcare Proxy Form

Printable West Virginia Healthcare Proxy Form

Printable Wisconsin Healthcare Proxy Form

Printable Wyoming Healthcare Proxy Form

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