Health Care Proxy Form Massachusetts: How to Fill It Out Correctly

A signed health care proxy is the single most important legal document a Massachusetts resident can execute. Without one, your spouse, adult children, and closest family members have zero legal authority to make medical decisions on your behalf. Massachusetts is one of the few states with no default surrogate consent law, which means doctors must petition the Probate and Family Court for a guardian if you become incapacitated without a proxy — a process that takes weeks and costs thousands.

The form itself is straightforward. Getting the execution details right is where most people fail.

What the Massachusetts Health Care Proxy Actually Does

Under Massachusetts General Laws Chapter 201D, a health care proxy appoints a Health Care Agent to make medical decisions if — and only if — your attending physician determines in writing that you lack the capacity to make decisions yourself. Until that written determination happens, the proxy sits dormant.

Your agent gains broad authority: they can consent to or refuse any medical treatment, including life-sustaining measures, surgical procedures, and transfers between care facilities. The agent is legally bound to follow your known wishes under the "substituted judgment" standard. If your wishes are unknown, the agent must act in your best interest.

The proxy does not give your agent authority over financial matters. That requires a separate Durable Power of Attorney.

Step-by-Step: Completing the Form

The official Massachusetts Health Care Proxy form is available free from the Massachusetts Medical Society and Honoring Choices Massachusetts. Here is exactly how to complete it:

Section 1 — Your Information: Print your full legal name, date of birth, and address. The form requires you to be at least 18 and mentally competent at the time of signing.

Section 2 — Naming Your Agent: Choose one person as your primary Health Care Agent. List their full name, address, and phone number. Your agent cannot be the operator of a healthcare facility where you are a patient, unless they are related to you by blood, marriage, or adoption.

Section 3 — Alternate Agent: Name a backup agent in case your primary agent is unavailable, unwilling, or unable to serve. This is optional but strongly recommended.

Section 4 — Special Instructions: This is where you document specific treatment preferences — whether you want or refuse life support, ventilators, feeding tubes, or other interventions. While Massachusetts does not recognize a standalone statutory "living will," these written instructions carry significant legal weight as evidence of your wishes.

Section 5 — Duration: The proxy remains valid indefinitely unless you specify an expiration date. Most people leave this open-ended.

Section 6 — Signatures: Sign and date the form in the presence of two adult witnesses.

Witness Rules That Void the Document

The witness requirements under MGL Chapter 201D, Section 2 are strict. Violating any of these rules renders your proxy legally invalid:

• You need two adult witnesses present when you sign
• Your appointed Health Care Agent cannot serve as a witness
• Your alternate agent cannot serve as a witness
• Best practice: witnesses should not be related to you by blood or marriage, should not be entitled to any portion of your estate, and should not be your attending physician or employees of your treating healthcare facility

No notarization is required under Massachusetts law. However, having the form notarized adds evidentiary weight if you travel out of state or if your capacity is ever contested.

Where to Keep Your Completed Proxy

Keeping your original in a bank safe deposit box defeats the purpose — it is inaccessible during a midnight emergency room visit. Instead:

• Give photocopies to your named agent and alternate agent
• Ask your primary care physician to scan the proxy into your electronic health record
• Provide a copy to any hospital or skilled nursing facility where you receive care
• Keep a copy in an accessible location at home (not locked away)
• If you have a MOLST or Comfort Care DNR, keep the proxy with those forms

Common Mistakes to Avoid

The most frequent errors that invalidate Massachusetts health care proxies:

1. Having your agent sign as a witness — this automatically voids the document
2. Using only one witness — the statute requires two
3. Not signing the form yourself — if you are physically unable to sign, you may direct another person to sign in your physical presence, but the witnesses must observe this
4. Confusing a health care proxy with a financial power of attorney — they are separate legal instruments with different purposes

How to Revoke or Update Your Proxy

You can revoke your health care proxy at any time while you still have mental capacity. Revocation happens through any of these methods:

• Executing a new health care proxy (automatically supersedes the old one)
• Delivering a signed written revocation to your agent or physician
• Making an oral statement of revocation witnessed by healthcare personnel
• Physically destroying the original document

One automatic trigger many people do not know about: if you appointed your spouse as your Health Care Agent, any subsequent divorce, annulment, or legal separation automatically revokes their appointment under Massachusetts law.

Next Step

The Massachusetts Advance Directive & Living Will Kit walks you through the complete proxy execution process with a witness eligibility checklist, a personal directive template for documenting your specific treatment preferences, and step-by-step instructions for coordinating your proxy with MOLST orders and homestead declarations.

See more Massachusetts guides →