New York Medical Power of Attorney Form [PDF]

Read our comprehensive guide on appointing someone to represent you by drafting the New York medical power of attorney.

Last update: 27 Mar 2024

New York Medical Power of Attorney Form [PDF]

The New York power of attorney, or healthcare power of attorney, is a legal document that enables one person, called the principal, to authorize another person, called the agent or the attorney-in-fact, to make important decisions about the principal’s healthcare.

The healthcare power of attorney is usually issued in the following situations:

When to Issue a Healthcare Power of Attorney

  • When the individual is of old age and desires to empower someone to make overall healthcare decisions on their behalf

  • In the event that the individual is diagnosed with a terminal illness

  • When the individual is about to undergo a potential surgery

  • If the individual wishes to authorize someone to make end-of-life decisions for them

Laws and Legal Requirements for a Medical Power of Attorney in New York

Laws and Legal Requirements

Sections 2980 to 2994 of the Consolidated Laws of New York regulate the status of medical power of attorney in New York.

Section 2981(2) provides that the principal must sign the medical power of attorney before at least two witnesses.

Section 2985 provides that the principal can revoke the medical POA at any time unless the court has determined that they are not able to do so. The principal can revoke the document by notifying their doctor, issuing a new medical POA, or filling out the power of attorney revocation form.

How to Write a Medical Power of Attorney in New York

To make a valid and effective medical power of attorney, your document must be in accordance with New York state laws and regulations. The following section provides a step-by-step guide on how to write a valid and effective medical power of attorney.

How to Write a Medical Power of Attorney

#1. Access the Medical Power of Attorney Form

Here, you can find the medical power of attorney form, which will include all the information that should be provided for the power of attorney to be effective and valid. 

Our advanced legal document builder will provide you with all the instructions on how to fill out the medical power of attorney template.

#2. Appoint a Healthcare Representative

A healthcare representative is a person who has the principal's authorization to make healthcare decisions on their behalf. The healthcare representative is also called the agent or the attorney-in-fact. 

Here, you should enter the full name, mailing address, and contact details of the attorney-in-fact.

The agent should be an adult with the legal capacity to act. Moreover, they should be someone you can trust, considering the importance of their authority. You can name your spouse, a blood relative, a friend, or any other trusted advisor. 

Here, you can also set medical power of attorney rights and limitations to determine your agent's scope of authority.

#3. Identify an Alternative Healthcare Representative

This person acts only in case the primary agent loses their legal capacity or is in some other way unable to represent the principal. Naming the alternative healthcare representative provides additional security for the principal by providing multiple healthcare representatives who can act. 

The alternative healthcare representative must fulfill the same requirements as the primary healthcare representative.

#4. Identify the Witnesses and Have Them Sign the Form

After completing the medical power of attorney form, you should print and sign it. The New York state law requires the presence of at least two witnesses when signing the medical POA. 

Witnesses must be of legal age and have the legal capacity to act. The healthcare representative cannot act as a witness.

#5. Notarize the Form

Although not required by state law, you can also have the notary public notarize your power of attorney. The notary public will confirm your identity and acknowledge that you have personally and freely signed the document.

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