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Making Decisions About Your Care in Advance
How to Plan for Your Care
with Advance Directives
Why is planning for your care important?
People of all ages should make their medical wishes known with an advance directive. This includes planning for a time when you may need help, or want someone to follow your instructions when you may not be able to make decisions for yourself. For example, if you have an accident or become seriously ill.
You can make decisions before something happens about the types of treatment you want to receive, like the use of a ventilator, artificial nutrition, resuscitation, and more. It is a gift you give yourself and your loved ones that can help avoid confusion and indecision, and help you and others in your life know that the care you receive is exactly what you wanted.
What can you do?
You can use legal documents, such as advance directives, to give instructions to doctors and others to know your wishes and plans regarding your health care. You can document your wishes and instructions by completing these forms.
- Name a health care representative, also known as a Health Care Proxy, or Health Care Agent to speak for you about your care and treatment.
- Leave written instructions through a Living Will or Advance Directives that explain your wishes.
- Let your doctor and care team know if you do not want life-saving emergency procedures performed – possibly including a do not resuscitate (DNR) medical order.
- Provide directions to hospitals, nursing homes, emergency medical technicians (EMTs), your doctor, and care team regarding your wishes in a Medical Orders for Life-Sustaining Treatment (MOLST) form or a Physician Orders for Life-Sustaining Treatment (POLST) form.
Where to get the forms
You can find Health Care Proxy, DNR, or POLST and MOLST forms at the State Department of Health.
We also sent you a blank health care proxy in your Welcome Kit when you joined the plan. Medicare members of EmblemHealth VIP Dual (HMO D-SNP) and EmblemHealth VIP Dual Reserve (HMO D-SNP) plans can get online help filling out these forms at emblemhealth.com/planmycare through our partner, WiserCare. This online tool will guide you and your loved ones through the important process of documenting your wishes and help you prepare the forms.
New York
Health Care Proxy (English)
Health Care Proxy (Spanish)
Health Care Proxy (Chinese)
Medical Orders for Life-Sustaining Treatment (MOLST)
Connecticut
Medical Power of Attorney (MOLST)
New Jersey
What to do with the forms
Completing these forms is easy. You don’t need to meet with a lawyer and you can update them as your wishes or medical situation changes.
After you get a form:
- Make sure you complete and sign the form.
- Determine if the form needs witnesses or a notary to make your wishes official.
- Share the signed form with your doctors, your chosen health care representative, family members, and/or friends as needed.
- Keep a copy for yourself, make sure the form is in your doctor’s medical record, and take it with you should you be hospitalized.
Last Updated: 10/01/2023
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