Laws
Statutes – Chapter 201D: Health Care Proxies
Definition – ”Health care proxy”, a document delegating to an agent the authority to make health care decisions, executed in accordance with the requirements of this chapter (201D § 1).
Signing Requirements – Acknowledgment of Two (2) Witnesses (201D § 2)
Revocation – 201D § 7
Other Versions (5)
- Baystate Health
- Central Mass. Partnership to Improve Care at the End of Life
- Dana-Farber Cancer Institute
- Honoring Choices Massachusetts
- Massachusetts Medical Society
Download: Adobe PDF
Central Mass. Partnership to Improve Care at the End of Life Version
Download: Adobe PDF
Dana-Farber Cancer Institute Version
Download: Adobe PDF
Honoring Choices Massachusetts Version
Download: Adobe PDF
Massachusetts Medical Society Version
Download: Adobe PDF
Multilingual Versions (9)
- Albanian
- Arabic
- Haitian Creole
- Khmer
- Portuguese
- Russian
- Spanish/Español
- Traditional Chinese
- Vietnamese
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Additional Resources
- Honoring Choices Massachusetts – Choosing a Health Care Agent
- Honoring Choices Massachusetts – Things to Know About a Health Care Proxy
- Honoring Choices Massachusetts – Who’s Your Agent?
- Massachusetts Medical Society – Planning Ahead Brochure (Spanish/Español)
- Tufts Health Plan – Types of Advance Directives for Massachusetts
Related Forms
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF
Comfort Care DNR Order Verification with Bracelet Inserts
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Medical Orders for Life-Sustaining Treatment (MOLST) Form
Download: Adobe PDF, MS Word (.docx)
Information: Adobe PDF
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