New Jersey Proxy Directive for Health Care

A proxy directive chooses a person

New Jersey calls its medical appointment a proxy directive. This two-page state form names a primary representative and two alternates in order. Your representative receives information needed for informed decisions and must use your wishes, or your best interests when those wishes cannot be determined. The appointment does not give control over your bank accounts or property.

Sources: [1] [3] [2]

Complete the treatment-authority choice

The form specifically asks you to initial whether the representative may decide about artificially provided fluids and nutrition. Read both alternatives before choosing. Another section lets you give directions or limits and attach additional pages. If you also use New Jersey’s separate instruction directive, make sure the documents agree and discuss both with the representative and your treating clinician.

Sources: [1] [3] [2]

Sign and circulate the complete directive

The published proxy uses two adult witnesses who are not the named representative or alternates. The state’s guidance also allows a notarial acknowledgment instead of the two-witness route. Follow one valid execution method and keep the dated appointment and its attachments together. Use the copy-recipient list to record who has the document. Your representative does not replace your own consent when you can make decisions; authority depends on the required incapacity determination.

Sources: [1] [2]

Related forms and guides

• New Jersey Power of Attorney Forms
• New Jersey Durable Financial Power of Attorney
• Medical Power of Attorney and Health Care Proxy Forms
• Medical vs. Financial Power of Attorney

Sources and verification

1. New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care; hosted by NJ Department of Health: source and instructions ↗ (opens in a new tab)
2. Authority and statutory guidance ↗ (opens in a new tab)
3. New Jersey Commission on Legal and Ethical Problems in the Delivery of Health Care; hosted by NJ Department of Health: complete document ↗ (opens in a new tab)

HTTP200, two-page PDF downloaded and text inspected; stateDOH FAQ independently checked for witness/notary alternatives and authority. No revision date printed.

The date above records a source check. It does not certify that a form is suitable for your circumstances or that an attorney has reviewed your document. Read the publisher’s current instructions before use.