Appointment of a Health Care Agent

A health care agent is a person you choose to make healthcare decisions
for you if you are unable to make decisions for yourself. 

Your agent should be someone who knows your wishes and will make decisions based on what he/she believes you would want, NOT based on his or her own preferences. Do not appoint someone and not tell him or her. A lawyer is NOT required and your signature may either be notarized or witnessed by two competent adults. If you are using two witnesses, neither may be the person appointed as your agent and at least one should be a person who is neither related to you nor entitled to any part of your estate. 

  1. Ask the person you want to be your agent if they are comfortable taking on this type of responsibility.
  2. Ask if they can be assertive with your physicians and other providers, if necessary, to get information to make decisions on your behalf.
  3. Ask if they are willing to follow your wishes, including refusing and stopping treatments if that is what you would want. 
  4. Talk with your agent about your choices, personal values and beliefs. Make sure they know what is important to you. Your agent may be asked to make decisions about CPR, medically administered food and water (tube feedings) and other interventions. Discuss your preferences in regard to these.
  5. Determine, if this person does not live near you, if they are willing and able to travel to make decisions for you.
  6. Choose an alternate agent.
  7. Give your agent a copy of the completed form.