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How do you choose a health care agent using the Health Care Proxy Form?

The first section of the form is where you write down the person(s) you choose as your health care agent and alternate agent. This is the only required section besides the signature sections. For your agent, you will need to list their name, home address, and telephone number. Your agent can be located anywhere, but it can be very helpful to have them live nearby so they can accompany you to medical visits or the hospital, if/when they become your decision-maker. This section of the form notes that you are authorizing your agent to make any and all healthcare decisions for you, unless you note otherwise, and that this proxy shall only take effect if and when you become unable to make your own health care decisions.

The second section of the form is where you can list an alternate agent (which is optional, but recommended), and you will also need to note their name, home address, and telephone number. Your alternate health care agent will only become your decision-maker if the first person you list is unable, unwilling, or unavailable to act as your health care agent.

You can name a spouse as your health care agent, or an adult child, neighbor or a friend, minister, or someone else. But whoever you name, that is the person who the doctor must consult, no one else, regardless of their relationship to you. We recommend you list an alternate health care agent if possible, as this could be valuable (for example, if both you and the person you list as your primary health care agent are in an accident together).

Since your health care agent will have the power to make your health care decisions, it should be someone you trust to follow your instructions. This may mean the person who would best serve as your agent may not necessarily be a person you are very close to, because sometimes it can be harder to make certain decisions. Ideally, your agent can make difficult decisions under pressure, and can advocate for you and be persistent. Ultimately, it is up to you to decide who is most likely to do exactly what you ask them to do.

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