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The instructions explain eligibility under Massachusetts law, limits on the Agent’s authority, required physician determination before activation, and how decisions are made based on the Principal’s wishes and best interests. It also covers witness/signature steps and optional statements for Agents and alternate Agents to support informed, values-based care decisions.",{"@graph":63,"@context":118},[64,80,101],{"@type":65,"itemListElement":66},"BreadcrumbList",[67,71,74,77],{"item":68,"name":69,"@type":70,"position":9},"https://docshare.wps.com","Home","ListItem",{"item":72,"name":10,"@type":70,"position":73},"https://docshare.wps.com/template/",2,{"item":75,"name":36,"@type":70,"position":76},"https://docshare.wps.com/template/forms/",3,{"item":78,"name":59,"@type":70,"position":79},"https://docshare.wps.com/template/massachusetts-health-care-proxy-information-instructions-and-form-read-and-complete/200751/",4,{"url":78,"name":59,"@type":81,"image":82,"author":87,"headline":59,"publisher":90,"fileFormat":93,"inLanguage":57,"description":61,"dateModified":94,"datePublished":95,"encodingFormat":93,"isAccessibleForFree":96,"interactionStatistic":97},"DigitalDocument",{"url":83,"@type":84,"width":85,"height":86},"https://docshare.wps.com/thumbnails/massachusetts-health-care-proxy-information-instructions-and-form-read-and-complete/200751.png","ImageObject",442,249,{"name":88,"@type":89},"Ava Thompson","Person",{"url":68,"name":91,"@type":92},"DocShare","Organization","application/pdf","2026-10-20","2026-09-04",true,{"@type":98,"interactionType":99,"userInteractionCount":45},"InteractionCounter",{"@type":100},"ViewAction",{"@type":102,"mainEntity":103},"FAQPage",[104,110,114],{"name":105,"@type":106,"acceptedAnswer":107},"Who can use the Massachusetts Health Care Proxy form?","Question",{"text":108,"@type":109},"Any competent adult age 18 or over may use the form to appoint a Health Care Agent. You can use it even if you do not live in Massachusetts, as long as you receive health care in Massachusetts.","Answer",{"name":111,"@type":106,"acceptedAnswer":112},"When can the Health Care Agent make decisions?",{"text":113,"@type":109},"The Agent can make decisions only when the Principal is unable to make or communicate health care decisions. A doctor must determine in writing that the Principal lacks that ability before the Agent acts.",{"name":115,"@type":106,"acceptedAnswer":116},"What authority does the Agent have and how are decisions guided?",{"text":117,"@type":109},"Acting with the Principal’s authority, the Agent can consent to or refuse medical treatment, including life-sustaining treatment if you granted full authority. Decisions should follow the Principal’s wishes, including religious or moral beliefs; if wishes are unknown, the Agent decides based on what he or she believes is in the Principal’s best interests.","https://schema.org",{"og:url":78,"og:type":120,"og:title":59,"og:site_name":91,"og:description":61},"article",{"robots":122,"canonical":78},"index,follow",{"doc_id":124,"site_id":56},200751,1788511969,{"code":4,"msg":5,"data":127},{"doc_id":124,"user_id":128,"nickname":88,"user_avatar":129,"doc_module":9,"category_id":35,"category_name":36,"doc_title":59,"doc_description":61,"doc_content":130,"file_id":131,"file_url":132,"file_type":133,"file_size":134,"view_count":45,"is_deleted":4,"is_public":9,"is_downloadable":9,"audit_status":9,"page_count":79,"language":135,"language_code":57,"site_id":56,"html_lang":57,"table_of_contents":136,"faqs":137,"seo_title":138,"seo_description":61,"update_tm":125,"read_time":73},1649267921044,"https://us-avatar.wpscdn.com/avatar/1800007509477c92dfb?_k=1786009248482753345","NOTICE: The following form is protected by federal copyright law and may be photocopied or reproduced only by the end user for his or her personal use. Health care organizations and others can contact Massachusetts Health Decisions, the nonprofit publisher of the form, for more information about reproducing the form. The form is available in English and 15 other [languages. Email: proxy@masshealthdecisions.org. Please visit](languages. Email: proxy@masshealthdecisions.org. Please visit) [https://](https://masshealthdecisions.org to)[masshealthdecisions.org to](https://masshealthdecisions.org to) find information for member of the public, clinicians, and health care provider organizations.  \nMASSACHUSETTS HEALTH CARE PROXY  \nInformation, Instructions, and Form  \nWhat does the Health Care Proxy Law allow?  \nThe Health Care Proxy is a simple legal document that allows you to name someone you know and trust to make health care decisions for you if, for any reason and at any time, you become unable to make or communicate those decisions. It is an important document, however, because it concerns not only the choices you make about your health care, but also the relationships you have with your physician, family, and others who may be involved with your care. Read this and follow the instructions to ensure that your wishes are honored.  \nUnder the Health Care Proxy Law (Massachusetts General Laws, Chapter 201D), any competent adult 18 years of age or over may use this form to appoint a Health Care Agent. You (known as the “Principal”) can appoint any adult EXCEPT the administrator, operator, or employee of a health care facility such as a hospital or nursing home where you are a patient or resident UNLESS that person is also related to you by blood, marriage, or adoption. Whether or not you live in Massachusetts, you can use this form if you receive your health care in Massachusetts.  \nWhat can my Agent do?  \nYour Agent will make decisions about your health care only when you are, for some reason, unable to do that yourself. This means that your Agent can act for you if you are temporarily unconscious, in a coma, or have some other condition in which you cannot make or communicate health care decisions. Your Agent cannot act for you until your doctor determines, in writing, that you lack the ability to make health care decisions. Your doctor will tell you of this if there is any sign that you would understand it.  \nActing with your authority, your Agent can make any health care decision that you could, if you were able. If you give your Agent full authority to act for you, he or she can consent to or refuse any medical treatment, including treatment that could keep you alive.  \nYour Agent will make decisions for you only after talking with your doctor or health care provider, and after fully considering all the options regarding diagnosis, prognosis, and treatment of your illness or condition. Your Agent has the legal right to get any information, including confidential medical information, necessary to make informed decisions for you.  \nYour Agent will make health care decisions for you according to your wishes or according to his/her assessment of your wishes, including your religious or moral beliefs. You may wish to talk first with your doctor, religious advisor, or other people before giving instructions to your Agent. It is very important that you talk with your Agent so that he or she knows what is important to you. If your Agent does not know what your wishes would be in a particular situation, your Agent will decide based on what he or she thinks would be in your best interests. After your doctor has determined that you lack the ability to make health care decisions, if you still object to any decision made by your Agent, your own decisions will be honored unless a Court determines that you lack capacity to make health care decisions.  \n© Massachusetts Health Decisions 1991-2026  \nLicensed for use by the Massachusetts Medica","cbCaidwiOT81xcdO","https://ap.wps.com/l/cbCaidwiOT81xcdO","pdf",745505,"English","# MASSACHUSETTS HEALTH CARE PROXY\n## What does the Health Care Proxy Law allow?\n## What can my Agent do?\n## How do I fill out the form?\n## Who should have the original and copies?","[{\"question\":\"Who can use the Massachusetts Health Care Proxy form?\",\"answer\":\"Any competent adult age 18 or over may use the form to appoint a Health Care Agent. You can use it even if you do not live in Massachusetts, as long as you receive health care in Massachusetts.\"},{\"question\":\"When can the Health Care Agent make decisions?\",\"answer\":\"The Agent can make decisions only when the Principal is unable to make or communicate health care decisions. A doctor must determine in writing that the Principal lacks that ability before the Agent acts.\"},{\"question\":\"What authority does the Agent have and how are decisions guided?\",\"answer\":\"Acting with the Principal’s authority, the Agent can consent to or refuse medical treatment, including life-sustaining treatment if you granted full authority. Decisions should follow the Principal’s wishes, including religious or moral beliefs; if wishes are unknown, the Agent decides based on what he or she believes is in the Principal’s best interests.\"}]","Massachusetts Health Care Proxy - Information, Instructions, and Form - Read and Complete | PDF"]