Structure of Typical Health Care Proxy Form in USA
Health care proxies are permitted in forty-nine states as well as the District of Columbia. Health care forms may differ in structure from state to state and pre-made forms are not compulsory as long as certain guidelines are met. The common guidelines include:
- Name and address of the agent.
- Name and address of an alternate agent.
- Duration of the proxy – not indicating a duration means it's valid unless stated otherwise.
- Special instructions – these can broaden or limit the powers of the agent. If the patient doesn't want to be on feeding tubes no matter what, this can be stated here. If there are certain treatments that the patient doesn't want to receive like dialysis or blood transfusion, then they must be indicated. However, if the patient wants to give the agent more flexibility with some or no restriction, this must be written.
- Name, date and signature of the primary individual.
- Instructions on tissue or organ donation.
- Two adult witnesses must sign the document stating that they have witnessed this agreement and that both parties appear to be sane. The witnesses must be 18 years or older. The agent and primary individual do not qualify as witnesses.
- Presence of a lawyer - such a person may help in drafting a document tailored to the needs of the primary individual.
- Once signed, copies of the form must be given to health care providers, the agent, spouse, and close friends. A copy should also be carried by the primary individual (in wallet or purse).
Read more about this topic: Health Care Proxy
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