“I Have A Health Care Proxy” Wallet Card

In case of emergency, your wallet card helps medical personnel quickly contact Health Care Agent.

HCP Card Folded

In 4 Languages:

I Have a Health Care Proxy.

Eu tenho uma Procuração de Cuidados de Saúde.

Tengo un Poder para tomar decisiones de atención médica.

I Have a Health Care Proxy Chinese

Make your own card. It's easy to do!

 

IMPORTANT: To use this card adults must have completed a Health Care Proxy which gives your Health Care Agent the legal authority to make decisions on your behalf. This informational wallet card is NOT a legal document. It does not replace your Health Care Proxy. Want to complete a free do-it-yourself Health Care Proxy?   Click here.

 

Printable Proxy Card-2021-09-26 EN

Adults who have completed a Health Care Proxy can make this handy wallet card to use in case of a medical emergency. The wallet card helps emergency personnel quickly contact your Health Care Agent and Alternative Agent. Your Agent can make health care decisions on your behalf and advocate for the care you want. 

 

Download and Print the wallet card instructions below. 

Just follow the simple instructions (pictured here) to cut out the wallet card and fold along the dotted lines. Fill out the card and store in your wallet.

HCP Card Folded

Instructions:

  1. Download and print on regular paper in color or black & white.
  2. First, cut out the card along the bold outline.
  3. Fold along the dotted lines.
  4. Fill out the card. Store in your wallet with your ID.

The  "I Have A Health Care Proxy" cover lifts up to reveal the contact information and closes to keep it protected. You can also write any information you like in the blank areas.

IMPORTANT: Adults must have a valid Health Care Proxy to use this wallet card. Your Health Care Proxy is your legal document that gives your Health Care Agent the authority to make health care decisions on your behalf. This informational wallet card is NOT a legal document. It does not replace your Health Care Proxy.