Massachusetts Health Care Proxy | Medical Power of Attorney

The Massachusetts  Advanced Health Care Proxy is sometimes called the Medical Power Of Attorney and is a form which gives the principal the choice over the health care they receive if  they are no longer able to advise on these decisions through illnesses such as unconsciousness or coma. This document is is in accordance to the US statutes §§ 1 – 17 and requires 2 witnesses.The Massachusetts advanced health Care Proxy also allows the principal to select another person known as an`Agent` to make their medical health care choices if they no longer be able to themselves through illnesses. The document is invalid if the principal becomes pregnant. Massachusetts does not recognize a living will. Rather, they instruct all citizens to create what is known as a ‘health care proxy’ or better known as a ‘medical power of attorney’.

How to Write

Health Care Proxy

1) The principal`s and the agent`s personal details must be entered.

  • Principal`s name.
  • Principal`s address and ZIP code.
  • Agent`s name.
  • Agent`s address and ZIP code.
  • Agents home and work telephone numbers.
  • Agent`s email address.


Limitations To Agent`s Authority

2) The principal is required to enter the specific details of and limitations they wish to impose on the agent`ts authority with respects to their end of life medical health care.



3) The principal must enter their details to signify that they understand the details of this Massachusetts Health Care Proxy.

  • Principal`s signature.
  • Date.

Alternatively if the principal is physically unable to sign the Massachusetts Health Care Proxy Then a surrogate may complete this section of the document in the presence of the principal and two witnesses.

  • Principal`s signature signed by surrogate.
  • Date.
  • Name of surrogate.
  • Address of surrogate.


Witness Statement

4) The witnesses to the Massachusetts Health Care Proxy must enter their details.

  • Witnesses signature.
  • Witnesses name.
  • Witnesses address.


Statement Of Health Care Agent (Optional)

5) The agent and alternative agent may sign the  Massachusetts Health Care Proxy document to declare that they understand this.