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A Medical Health Care Proxy is a legal document in which a patient’s medical team and loved ones come to a consensus and appoint a decision maker who will represent the patient’s medical interests. In other words, if a person has not appointed someone as their Health Care Agent by using a Medical Durable Power of Attorney, the law may do it for the person.

A Proxy Decision Maker will be called for input and decision making in any situation where a Health Care Agent is needed. However, they cannot make the decision to end artificial nutrition and hydration without the agreement of two physicians who certify that receiving artificial nutrition and hydration is only prolonging death.

The Medical Health Care Proxy form is completed by the patient’s medical doctor in the hospital or other health care institutions such as a nursing home or assisted living.

There is no state approved form. Each health care institution can prepare their own form. Most health care institutions do accept the health care proxy, but the “receiving” health care institutions does not have to accept the “sending” health care institutions health care proxy.

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Things to Know

If a person has completed a MDPOA, a Medical Care Proxy is not needed. This form is only to be used when a person has not appointed someone as their agent by using a MDPOA.

The form is completed by the patient’s medical doctor in the hospital or other health care institutions such as a nursing home or assisted living.

The Proxy Decision Maker cannot make the decision to end artificial nutrition and hydration without the agreement of two physicians who certify that receiving artificial nutrition and hydration is only prolonging death.

Download a Sample Medical Health Care Proxy

Download Proxy Form (English)

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