Quick Start: Make Your Own Health Care Proxy
It's quick and easy to do. Have a simple conversation with a trusted person to be your Health Care Agent, and complete a Health Care Proxy document.
Starting at 18 years old, you can choose a person you trust to be your Health Care Agent!
If you get sick and are not able to make care decisions yourself, even for a short time while you get better, your Health Care Agent can step in with the power to talk with your doctors and make health care decisions to get you the care you want.
Under Massachusetts law, you must appoint or write-in your Health Care Agent's name in a document called a Health Care Proxy. A family member or friend does not automatically have the legal power to make health care decisions for you unless appointed in a Health Care Proxy.
Here's how it works
You can do it yourself. Click on the links below to see helpful video and download free documents and tools.
1. Choose a Health Care Agent
- Choose a person you trust, like a family member, friend, or anyone you like to be your Health Care Agent.
- Watch the Choosing a Health Care Agent video (in 4 languages).
2. Complete a Health Care Proxy
3. Share your Health Care Proxy
- Give a copy of your completed Health Care Proxy to-
- your Health Care Agent; and,
- your primary care doctor to scan into your medical record.
- If you like, download the handy conversation guide to talk with your doctor and care teams to stay well and align care to your goals, priorities and preferences.
Not able to choose a Health Care Agent? That's Okay.
Start with a Personal Directive or Living Will document.
- You can write down your care preferences in a Personal Directive (Living Will) and share it with your doctor and care teams.
- Download and print a Personal Directive (in 4 languages)
Share with family, friends and your community.
- Share the 1-page consumer handout: Who Is Your Health Care Agent? so every adult can make a Health Care Proxy.
- Download and print the Consumer Handout below (in 9 languages).
Helpful Videos, Free Documents and Conversation Guides
Video: Choosing a Health Care Agent.
Watch the short video and follow the 3 simple steps to choose a Health Care Agent, complete a Health Care Proxy document, and share your completed Health Care Proxy with your doctors and care team.
English
Spanish (Latin) Translation
Portuguese (Brazil) Translation
Traditional Chinese Translation
Download and Print a Health Care Proxy
You can complete an Honoring Choices MA Health Care Proxy with the help of two adults acting as witnesses. You do not need a lawyer or a notary public. You can do-it-yourself!
Português - Portuguese PDF
Tiếng Việt - Vietnamese PDF
Kreyòl Ayisyen - Haitian Creole PDF
Kiswahili - Swahili download PDF
Polish - Polski PDF
Kabuverdianu - Cape Verdean Creole PDF
Visit and watch video: How To Complete an Honoring Choices Health Care Proxy
Step by step guide to complete your own Honoring Choices Health Care Proxy, signed by two witnesses. (English).
Download and Print: "I Have a Health Care Proxy" Wallet Card
English - English PDF
Español - Spanish PDF
Português - Portuguese PDF
繁體中文 - Traditional Chinese PDF
Tiếng Việt - Vietnamese PDF
Kreyòl Ayisyen - Haitian Creole PDF
Kabuverdianu - Cape Verdean Creole PDF
Download and Print the Getting Started Tool Kit
You can download a single Health Care Proxy document and wallet card OR download the Getting Started Tool Kit which includes informational facts sheets and a-
- MA Heath Care Proxy
- MA Personal Directive (Living Will)
- "I Have a Health Care Proxy" Wallet Card
- "Start a Simple Conversation to Stay Well" conversation guide to talk with your doctors and care teams.
Download and Print Consumer Conversation Guides
Start a planning conversation with your health care provider to talk about your care goals and preferences, using our handy Consumer Conversation Guides. Start with Guide 1 and build on your conversations over your lifetime.
Consumer Conversations Guides: 5 Things to Talk About with Your Care Providers.
Guide 1: Start a Simple Conversation to Stay Well (PDF)
Guide 2: Managing Health and Chronic Illness (PDF)
Guide 3: Living Well with Serious Illness (PDF)
Guide 4: Let's Talk about Palliative Care (PDF)
For Care Providers: Download and print the Care Providers Conversation Guides 1-4 Series. The guides mirror the Consumer Conversation Guides to engage in effective conversations. Download the pdf's for Care Providers here.
Download and Print the Personal Directive (Living Will)
A Personal Directive or Living Will is a personal document where you can write down what's important to you and how you want to be cared for, if you are not able to make or communicate health care decisions yourself. It can be used in two ways:
- If you can choose a Health Care Agent, the Personal Directive is important information and instructions for your Agent;
- If you are not able to choose a Health Care Agent, you can start to make your health care plan with a Personal Directive and share it with your doctors and care teams.
Download and print Personal Directive (Living Will) document, using text only (in 5 languages).
Download and print an Adult & Supportive Person Tool Kit for adults with a range of abilities, to create a Personal Directive using graphics, pictures and text.
Distribute the "Who is Your Health Care Agent?" Consumer Handout
Help every adult in your community access a free Health Care Proxy. You can co-brand the consumer handout with your logo and add a QR code if you like to download a Health Care Proxy from your website.
Everyone can print the free multi-lingual consumer handout and distribute to adults in your community!
The Who is Your Health Care Agent? handout (pictured here) offers accurate information on choosing a Health Care Agent and completing a Health Care Proxy. The handout's QR code links to the Honoring Choices MA Quick Start page to download a free multi-lingual Health Care Proxy document and view "how to" videos.
The MA Department of Public Health has partnered with Honoring Choices MA and Massachusetts Health & Hospital Association to promote a statewide Health Care Proxy Campaign using the Who is Your Health Care Agent? consumer handout and planning documents. Download and read the introductory letter (PDF).
You can co-brand the multi-lingual consumer handout with your group's logo and add your QR code. Choose the languages best for your community. Contact Ellen, edipaola@honoringchoicesmass.com
The Who is Your Health Care Agent? Handout is available in 9 languages:
Kreyòl Ayisyen - Haitian Creole (PDF)