Free New York Advance Directive Form (Medical POA & Living Will) | PDF

New York Advance Directive Form (Medical POA & Living Will)

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.

Last updated September 24th, 2024

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.

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Advance Directive

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

Statutes – Consolidated Laws of New York – Chapter 45 – Article 29C – Health Care Agents and Proxies (§ 29C-2980 – 29C-2994)

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

New York State Senate Version

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)

Advance Directive Wallet Card

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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