Massachusetts Health Care Proxy (Page 2 of 3) in pdf

Massachusetts Health Care Proxy Page 2

A Health Care Proxy must be signed in front of two adult witnesses. The person you appoint as

your Health Care Agent or as an alternate Agent cannot be a witness.

It is important that you communicate your wishes, religious or moral beliefs and health care

preferences to your Health Care Agent so that he or she will be able to make decisions for you in

accordance with your wishes.

Who should keep my signed Health Care Proxy?

Be sure to give a copy to your Agent, any Alternate Agent, and your doctor to put into your

medical record, and to anyone else you choose. You should keep the original Health Care Proxy

where it can be easily found.

Can I revoke my Health Care Proxy in the future?

You may revoke the Health Care Proxy at any time by:

 Signing another Health Care Proxy in the future;

 Legally separating or divorcing your spouse who is named as your Health Care Agent;

 Notifying your Agent, doctor, or other health care provider, verbally or in writing, that

you have revoked your Health Care Proxy; or

 Taking any other action that demonstrates your intent to revoke the proxy.

Prepared by Volunteer Lawyers Project

Massachusetts Health Care Proxy Page 2