Quick Start: Choose a Health Care Agent and Complete a Health Care Proxy
It's quick and easy to do with free documents and helpful videos!
Starting at 18 years old, you can choose a person you trust to be your Health Care Agent!
If you get sick and are not able to make care decisions yourself, even for a short time while you get better, your Health Care Agent can step in with the power to talk with your doctors and make decisions to get you the care you want.
In Massachusetts, you must appoint or write-in your Health Care Agent's name in a document called a Health Care Proxy. A family member or friend does not automatically have the legal power to make health care decisions unless appointed in a Health Care Proxy.
Here's how it works:
1.Choose a Health Care Agent
- Watch the Choose a Health Care Agent video below (in 4 languages).
- Choose a person you trust, like a family member, friend, or anyone you like to be your Health Care Agent.
2. Complete a Health Care Proxy
- Download free Health Care Proxy documents below (in 16 languages).
- You can do-it-yourself. Print the free Health Care Proxy.
- Make you own "I Have a Health Care Proxy" Wallet Card below (in 7 languages).
3. Share your Health Care Proxy
- Give a copy of your Health Care Proxy to your Health Care Agent.
- Give a copy to your doctor to scan into your medical record.
- If you like, download the handy Conversation Guides below to talk about care that's right for you.
Not able to choose a Health Care Agent? That's Okay.
Start with a Personal Directive or Living Will document.
- You can write down your care preferences in a Personal Directive(Living Will) and share with your doctor and care team.
- Learn more and download a Personal Directive (in 4 languages)
Help Adults in Your Community
See our Who Is Your Health Care Agent? Consumer Handout below (in 9 languages).
- Download and distribute the consumer handout for equal access to a free multilingual Health Care Proxy!
- Join the MA Department of Public Health in their Health Care Proxy Campaign.
- Be a Trusted Source of Information in Your Community.
Choosing a Health Care Agent: Watch the Video
Watch the short video and follow the 3 simple steps to choose a Health Care Agent, complete a Health Care Proxy document, and share your completed Health Care Proxy with your doctors and care team.
English
Spanish (Latin) Translation
Portuguese (Brazil) Translation
Traditional Chinese Translation
Download and Print a Health Care Proxy
You can complete an Honoring Choices MA Health Care Proxy with the help of two adults acting as witnesses. You do not need a lawyer or a notary public. The Honoring Choices Health Care Proxy has a simple instructions page and a 1-page document.
Português - Portuguese PDF
Tiếng Việt - Vietnamese PDF
Kreyòl Ayisyen - Haitian Creole PDF
Kiswahili - Swahili download PDF
Polish - Polski PDF
Kabuverdianu - Cape Verdean Creole PDF
Visit and watch video: How To Complete an Honoring Choices Health Care Proxy
Step by step guide to complete your own Honoring Choices Health Care Proxy, signed by two witnesses. (English).
Download and Print: "I Have a Health Care Proxy" Wallet Card
English - English PDF
Español - Spanish PDF
Português - Portuguese PDF
繁體中文 - Traditional Chinese PDF
Tiếng Việt - Vietnamese PDF
Kreyòl Ayisyen - Haitian Creole PDF
Kabuverdianu - Cape Verdean Creole PDF
Download and Print Consumer Conversation Guides
Start a planning conversation with your health care provider to talk about your care goals, priorities and care preferences, using our handy Consumer Conversation Guides. Start with Guide 1 and build on your conversations as your health needs and care preferences change.
Consumer Conversations Guides 1-4: 5 Things to Talk About with your Care Providers.
Guide 1: Start a Simple Conversation to Stay Well (PDF)
Guide 2: Managing Health and Chronic Illness (PDF)
Guide 3: Living Well with Serious Illness (PDF)
Guide 4: Let's Talk about Palliative Care (PDF)
For Care Providers: Download and print the Care Providers Conversation Guides 1-4 Series. The guides mirror the Consumer Conversation Guides to engage in effective conversations. Download the pdf's for Care Providers here.
Who is Your Health Care Agent? Consumer Handout
Help adults in your community access a free Health Care Proxy! You can co-brand the multi-lingual consumer handouts with your group's logo and QR code, and distribute anywhere adults gather, live and receive care.
Everyone can print the free multi-lingual consumer handout and distribute to adults in your community!
The Who is Your Health Care Agent? handout (pictured here) offers accurate information on choosing a Health Care Agent and completing a Health Care Proxy. The handout's QR code links to the Honoring Choices MA Quick Start page to download a free multi-lingual Health Care Proxy document and view "how to" videos.
The MA Department of Public Health has partnered with Honoring Choices MA and Massachusetts Health & Hospital Association to promote a statewide Health Care Proxy Campaign using the Who is Your Health Care Agent? consumer handout and planning documents. Download and read the introductory letter (PDF).
You can co-brand the multi-lingual consumer handout with your group's logo and add your QR code. Choose the languages best for your community. Contact Ellen, edipaola@honoringchoicesmass.com
The Who is Your Health Care Agent? Handout is available in 9 languages:
Kreyòl Ayisyen - Haitian Creole (PDF)
Join the MA Department of Public Health's Health Care Proxy Campaign!
The MA Department of Public Health's Health Care Proxy Campaign helps to ensure equal access to care planning information and documents for everyone in the Commonwealth.
The MA Department of Public Health (MA DPH) has partnered with Honoring Choices MA and Massachusetts Health and Hospital Association (MHA) to support a statewide Health Care Proxy Campaign, using the Honoring Choices Who is Your Health Care Agent? consumer handout and no cost multilingual planning documents and tools. Read announcement.
Whether you are a consumer, a community group or organization, you can download and share the free Who Is Your Health Care Agent? consumer handout anywhere adults live, receive care, and gather! Every handout links to the Quick Start page to access a free multilingual Health Care Proxy and other tools. Groups can co-brand the multilingual consumer handouts with their organization’s logo and QR code to tailor to their community. For more information, contact Ellen, edipaola@honoringchoicesmass.com
Be a Trusted Source of Information in Your Community!
Join us- Be a trusted source of health care planning information and distribute the consumer handout and planning documents to adults in your community. Support your staff in engaging adults in simple care planning conversations to choose a Health Care Agent and complete a Health Care Proxy and/or Personal Directive (Living Will).
Here are some of the Honoring Choices Partners & Friends who tailored the tools for their community. We can co-brand the multilingual consumer handouts with your organization’s logo and QR code at no cost. Cost. For more information, contact Ellen, edipaola@honoringchoicesmass.com
MA Health & Hospital Association Simple Step Campaign
All MA Hospitals and Cross-Continuum Professionals
Helps adults to take a simple step to complete a Health Care Proxy & Personal Directive (Living Will).
South Shore Patients, Primary Care & Care Management Staff
Provides co-branded handouts & Health Care Proxy in English, Spanish, Arabic, Portuguese, Haitian-Creole.
Health Clinics, Flu Clinics, and Community Events in Lynn
Provides co-branded handouts in English, Spanish, Haitian-Creole, Khmer.
Dementia Friends MA Champions helping Adults & Families; Community Events
Provides handouts, planning tools; See Dementia Friends MA information flyer (10 languages)
MassNAELA Health Care Proxy Clinics
Brings Mobile Clinics to Community Health Centers
Provides documents & videos: English, Spanish, Portuguese, Haitian-Creole. Clarence Richardson, Clarence@MassNAELA.com
Life Care Managers provide holistic services to navigate the aging journey.
Provides handouts Health Care Proxy & Personal Directive (Living Will).
Greater Springfield Senior Services
Consumer Presentations: "Now's the Time. Make Your Own Care Plan"
Provides adults with the Getting Started Tool Kit, multilingual documents.
Nantucket Palliative & Supportive Care
Adults & families and Community Events
Provides handouts, Getting Started Tool Kit, multilingual documents
LifePath, Western & North Central MA
Berkshire Consumer Healthy Living Workshops; Honoring Choices Ambassadors
Provides handouts, Health Care Proxy, Getting Started Tool Kit.
Your Elder Experts, JF&CS, Jewish Family & Children's Services of Greater Boston
Aging Life Care Managers helping Adults & Families
Provides care planning information and Health Care Proxy.
AgeSpan, North Shore
North Shore Housing Program Residents; Honoring Choices Ambassadors
Provides handouts, Health Care Proxy, Getting Started Tool Kit.
Health Clinics, Flu Clinics, Community Events in Abington
Provides co-branded handouts in English, Portuguese, Haitian-Creole, Vietnamese.
MA Health & Hosptial Association Simple Step: A Cross-Continuum Initiative
Your organization can help adults take a simple step to complete a Health Care Proxy.
The Massachusetts Health & Hospital Association (MHA), Honoring Choices and leading cross-continuum organizations have come together to support the Simple Step Campaign, to engage every adult in a simple conversation to choose a Health Care Agent and complete a Health Care Proxy. If adults are not able to choose a Health Care Agent, care professionals can offer a Personal Directive (Living Will). The Personal Directive helps adults write down their care preferences and share with their care providers.
It's easy to include the Simple Step Campaign to your organization's workflow. MHA provides the no cost Simple Step campaign materials, Honoring Choices multi-lingual planning documents and tool kits, and a 30 minute staff training to confidently engage adults in simple conversations.
Join us! All community groups and health care systems are very welcome to join the campaign. Let's ensure every adult across the Commonwealth has early and equal access to health care planning.
Download Multilingual Documents and Tools. Watch Helpful Videos.
Print a no cost Health Care Proxy, Wallet Card, and Personal Directive. Watch helpful videos.
Health Care Proxy
Español - Spanish
Português - Portuguese
Tiếng Việt - Vietnamese
Kreyòl Ayisyen - Haitian Creole
Kiswahili - Swahili
नेपाली - Nepali
简体中文 - Simplified Chinese
Tagalog - Tagalog
Русский - Russian
繁體中文 - Traditional Chinese
عربي - Arabic
ភាសាខ្មែរ - Khmer
Shqip - Albanian
Polish- Polski
Kabuverdianu- Cape Verdean Creole
Accessibility
Screen reader accessible: Use screen reader and fill-able online documents. Learn more.
Watch Short Videos
Who is Your Health Care Agent?: Choosing a Health Care Agent
Choose a trusted person to be your Health Care Agent and talking about how you want to be cared for over your lifetime.
- English; Subtitles in Spanish, Portuguese, Chinese
How To Complete an Honoring Choices Health Care Proxy
Easy step by step guide to completing your own Honoring Choices Health Care Proxy, signed by two witnesses. (English).
"I Have a Health Care Proxy" Wallet Card
Medical staff can call your Health Care Agent in an emergency.
Español -Spanish
Português - Portuguese
繁體中文 -Traditional Chinese
Tiếng Việt - Vietnamese
Kreyòl Ayisyen - Haitian Creole
Kabuverdianu -Cape Verdean Creole