Advance Care Planning

Health Care Proxy Form

Massachusetts Health Care Proxy Form [PDF], a two-page form, conforming to Massachusetts law that designates your Health Care Agent and Alternate.

If you are completing Health Care Proxy Forms in Spanish or Vietnamese:

Spanish Instructions [PDF]
Spanish Health Care Proxy Form [PDF]
Vietnamese Instructions [PDF]
Vietnamese Health Care Proxy Form [PDF]

*Please note that these instructions and forms are based on Massachusetts laws. Health Care Proxy laws and protocols, as well as the legal status of personal wishes statements, vary from state to state.