Connecticut Health Care Proxy Form: How to Appoint a Health Care Representative

Connecticut does not use the term "health care proxy" in its statutes. The state calls this role a "health care representative" — and the distinction matters because the legal authority, appointment process, and limitations are defined specifically under Connecticut General Statutes § 19a-575a through § 19a-580c.

If you are appointing someone to make medical decisions when you cannot, here is exactly how the process works, what authority the role carries, and the execution requirements that hospitals check before honoring the appointment.

What a Connecticut Health Care Representative Can Do

Once activated, your health care representative has the legal authority to:

• Make all medical decisions you could make yourself, including consent to or refusal of treatment
• Access your medical records and consult with your physicians
• Authorize or refuse surgery, medication, and diagnostic procedures
• Direct hospice care and end-of-life treatment decisions
• Carry out the instructions in your living will

The representative's authority activates only when your attending physician determines you lack the capacity to make your own medical decisions. Until that determination, the representative has no authority — you remain in control.

How to Appoint a Health Care Representative

The appointment is made through Connecticut's combined advance directive form, published by the Office of the Attorney General. The health care representative designation is Section 1 of this form.

You must name:

• A primary health care representative — your first choice
• An alternate health care representative — who steps in if your primary is unavailable, unwilling, or unable to serve

You can include specific instructions limiting or expanding the representative's authority. Without written limitations, Connecticut law grants broad decision-making power that mirrors what you could decide for yourself.

Who Can Serve

Any competent adult can serve as your health care representative. There are no residency requirements — your representative does not need to live in Connecticut. Common choices include a spouse, adult child, sibling, or trusted friend.

Who Cannot Serve

Connecticut does not impose broad restrictions on who can be your representative, but the person you appoint cannot also be one of your two required witnesses. This is the single most common execution error and the reason hospitals reject advance directives.

Execution Requirements

The combined advance directive — including the health care representative section — must be:

1. Signed by you (the principal) while you have decision-making capacity
2. Witnessed by two adults who are present when you sign
3. Not witnessed by your appointed representative — this is explicitly prohibited

Notarization is optional for the directive itself. However, Connecticut offers a witness affidavit under C.G.S. § 19a-578 that, when notarized, creates prima facie evidence the document was properly executed. This is worth doing — it shifts the burden of proof to anyone who challenges the document.

Special Facility Rules

If you are a resident of a facility operated or licensed by the Department of Mental Health and Addiction Services (DMHAS) or the Department of Developmental Services (DDS):

• At least one witness must be unaffiliated with the facility
• At least one witness must be a physician, advanced practice registered nurse (APRN), or licensed clinical psychologist

These additional requirements exist to protect vulnerable populations from undue influence.

Health Care Representative vs. Financial Power of Attorney

This is where Connecticut residents get tripped up most often. The health care representative and the financial power of attorney are two completely different legal instruments with different execution requirements:

A document that meets health care representative requirements may not meet financial POA requirements — and vice versa. If you need both (most people do), you must execute them separately with the correct formalities for each.

Banks and financial institutions in Connecticut routinely reject powers of attorney that lack notarization, even if they have two witnesses. A health care representative appointment will not give your agent access to bank accounts, investment portfolios, or real estate transactions.

What Happens Without a Health Care Representative

If you lose capacity without a designated representative, Connecticut law allows certain family members to make medical decisions on your behalf — but the hierarchy is rigid and does not always match your preferences. The attending physician will look to a court-appointed conservator first, then a spouse, then an adult child, then a parent.

Family disagreements in this scenario can delay critical medical decisions, force families into probate court for conservatorship proceedings, and create lasting damage to family relationships. Appointing a representative in advance eliminates this entirely.

After the Appointment

Once the form is executed:

• Give copies to your representative, alternate representative, and primary care physician
• Provide a copy to any hospital or long-term care facility where you receive care
• Keep the original in an accessible location — not a safe deposit box
• Review the appointment after major life events (marriage, divorce, the representative's death or incapacity)
• You can revoke the appointment at any time by notifying your representative and physician in writing

The Connecticut Advance Directive & Living Will Kit includes the complete combined form with section-by-section instructions, a witness eligibility checklist, and a distribution tracker to make sure your appointed representative can actually act when the time comes.

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