The New York Advance Directive represents a binding written understanding of a person’s wishes regarding health care options should there be a situation where they cannot communicate their needs. The integration of three different forms helps to provide a comprehensive outline of a principal party’s requests in the event of possible physical or mental incapacitation. The health care proxy portion is intended to establish a confirmed agent to make decisions for the declarant if there comes a time where it is deemed necessary. The living will and MOLST portions of the agreement further create an integrated recognition of the principal individual’s preferences concerning possible scenarios, including pain management, life-sustaining treatment, or medical resuscitation. Fill out the paperwork accordingly and sign in the presence of two (2) witnesses to legitimatize the commitment.
Instructions/Information: Adobe PDF
This document contains the following sections:
- Part I: Medical Power of Attorney (Health Care Proxy)
- Part II: Living Will
- Part III: Medical Orders for Life-Sustaining Treatment (MOLST)
Laws
Definition – “Advance directive” means a type of written or oral instruction relating to the provision of health care when an adult becomes incapacitated, including but not limited to a health care proxy, a consent to the issuance of an order not to resuscitate or other medical orders for life-sustaining treatment (MOLST) recorded in a patient’s/resident’s medical record, and a living will (10 CRR-NY § 400.21(1))
Signing Requirements – Two (2) acceptable witnesses must be on location at the moment of endorsement to confirm the execution of the agreement (§ 29C-2981.2).
Revocation – § 29C-2985
Other Versions (6)
- AARP (Caring Connections)
- Compassion and Support NY
- Five Wishes (Aging with Dignity)
- NY Assoc. of Psychiatric Rehabilitation
- New York State Senate Version
- Prepare for Your Care
AARP (Caring Connections) Version
Download: Adobe PDF
Instructions: Adobe PDF
Compassion and Support New York Version (also available in Spanish/en Español)
Download: Adobe PDF
Five Wishes (Aging with Dignity) Version
Download: Adobe PDF
Information: Adobe PDF
New York Association of Psychiatric Rehabilitation Services Version
Download: Adobe PDF
Information: Adobe PDF
Download: Adobe PDF
Instructions/Information: Adobe PDF
Prepare for Your Care Version (also available in Spanish/en Español)
Download: Adobe PDF
Additional Resources
- Compassion and Support New York – Advance Care Planning
- End of Life Choices New York – Specific Advance Directives
- Law Help NY – Health Care Proxies and Living Wills
- New York Attorney General – Advanced Directives Guide
- New York Attorney General – Planning Your Health Care in Advance
- New York City Department of Health – Advance Directives Health Bulletin
- New York Department of Health – Advance Care Planning
- New York Department of Health – DNR and MOLST
- New York State Catholic Conference – End-of-Life Decisions: Advance Directives
- New York State Donate Life – Registry Enrollment Form
- Rochester Regional Health – Advance Directives (Living Will) and Healthcare Proxy
- United Health Services – Advance Directives
Related Forms (4)
- Advance Directive Wallet Card
- Durable (Financial) Power of Attorney Form
- MOLST Form
- Nonhospital Order Not to Resuscitate (DNR Order)
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Medical Orders for Life-Sustaining Treatment (MOLST)
Download: Adobe PDF
Instructions: Adobe PDF
Nonhospital Order Not to Resuscitate (DNR Order) (also available in Spanish/en Español)
Download: Adobe PDF
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