Massachusetts Health Care Proy Assignment Page 2
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4directions. If the provider is unable to arrange such a transfer, that provider must either honor
your proxy’s directions or must go to court for a decision.
V. Witnesses
Two competent adults must witness your Health Care Proxy form. However, your Health Care
Proxy him or herself cannot be one of these witnesses.
VI. Right to Revoke This Assignment
You have the right to revoke your proxy’s authority to make health care decisions for you at
any time. You may revoke this authority orally or in writing (it is strongly recommended that
you revoke the authority in writing).
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