Health Care Proxy Form
BINGHAMTON, NY - When a person makes an organ or tissue donation, it has the potential to do so much good for someone in need that it is rightfully known as giving the gift of life. It's now easier to help the growing number of people awaiting these life-saving gifts with the New York State Department of Health's revised, simplified Health Care Proxy form.
"On this form, a person can make a gift of any organ or tissue that is needed or can place limits on what they wish to donate," said Claudia Edwards, Public Health Director of the Broome County Health Department.
More than 80,000 people nationwide, including nearly 8,000 New Yorkers, are waiting for organ transplants. In New York State, 20,000 people – many of them burn and cancer patients- are among the tens of thousands of Americans who need tissue transplants so that they can resume full, productive lives.
"The opportunity to donate organs or tissue is one more way the Health Care Proxy helps assure patients will remain in control of their health care treatment," Ms. Edwards said.
For more than 10 years, the Health Care Proxy form has allowed individuals to record their wishes regarding medical care, giving them the assurance that they will remain in control of their health care treatment, no matter what their medical conditions.
By signing a Health Care Proxy form, a person appoints a trusted agent, such as a family member or close friend, to make health care decisions on his or her behalf. Individuals can inform their proxy agent verbally or in writing about desired end-of the-life care and provide specific instructions on the proxy form about what measures should be taken including the decision to remove or provide life-sustaining treatment. The person can put limits on the agent's authority, and include his or her own specific instructions about medical care.
Completing a Health Care Proxy form does not require consultation with an attorney, and signed earlier versions remain valid. Health Care Proxy forms should be checked periodically to assure that the individual's wishes have not changed.
The revised, simplified Health Care Proxy form is available on the State Health Department's Web site at www.health.state.ny.us. Click on "Information for Consumers."
To request a paper version of the form in English, Spanish, Russian or Chinese, write:
Publications
Box 2000
Albany, NY 12220
CONTACT:
Diane O'Hora, Supervising Public Health Educator,
Broome County Health Department, 607.778.3921
email: dohora@co.broome.ny.us
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