The Paper You Sign Before It Matters
Imagine this scenario. It is a Tuesday morning in late March. Your parent wakes up after a minor fall at home. Within a few hours, the doctor says your parent cannot make decisions on their own anymore. The next question asked is not about insurance or medication. The doctor simply asks: does anyone have the health care proxy form?
In my career as a New York State Remote Online Notary, I have witnessed this moment dozens of times. Families scrambling through closets, half-remembered conversations about the doctor, and the quiet stress of not knowing whether a loved one has their medical decisions properly documented. The good news is that advance directives are among the simplest legal documents to execute – and with remote online notarization, you do not even need to leave your home.
In this guide, I will walk you through everything you need to know about advance directives in New York State, how remote online notarization ensures your documents meet full compliance, and why taking this step now is one of the smartest things you can do for yourself and your family.
What Are Advance Directives?
An advance directive is a legal document that allows you to make provisions for future health care decisions in case you are unable to make them for yourself. The term covers several different types of documents, each serving a distinct purpose. In New York State, the main categories include the health care proxy form, the living will, the do-not-resuscitate order, and the medical orders for life-sustaining treatment form.
The New York State Attorney General defines an advance directive as a legal document by which you may make provisions for future health care decisions in the event that you are unable to make such decisions for yourself. These documents are not reserved for the elderly or chronically ill. Any adult in New York who is at least 18 years of age can create them, and they are free, widely available, and remarkably straightforward to execute.
The Four Types of Advance Directives in New York
1. Health Care Proxy
A health care proxy lets you appoint someone you trust as your health care agent – a person who will make medical decisions on your behalf when you lose the capacity to do so yourself. Under New York Public Health Law Article 29-C, your agent’s authority begins when your attending physician determines in writing that you are no longer capable of making or communicating health care decisions.
This is the most commonly executed advance directive, and for good reason. Unlike a living will that spells out your specific wishes in writing, a health care proxy gives you a flexible decision-maker who can respond to situations you may never have anticipated.
The NY State Department of Health provides a standard health care proxy form available in multiple languages including English, Chinese, Haitian Creole, Korean, Russian, and Spanish. You can download it directly from the DOH website.
2. Living Will
A living will is a written statement of your specific health care preferences, especially regarding end-of-life care. While New York does not have a formal statute governing living wills, the Court of Appeals – New York’s highest court – has confirmed that living wills are valid as long as they provide clear and convincing evidence of your wishes.
Your living will can specify whether you want to be kept alive on machines, whether you prefer tube feeding if you are terminally ill, and whether you want maximum pain relief even if it hastens your death. There is no standard state form for a living will, but the New York Attorney General provides a free template that covers the most common situations.
Many clients choose to execute both a health care proxy and a living will together. The two documents work beautifully as a team. Your living will states your specific wishes in writing, and your health care agent interprets and applies those wishes to real-time medical situations.
3. Do Not Resuscitate Orders (DNR)
A DNR is a written medical order from your doctor instructing health care providers not to perform cardiopulmonary resuscitation if your heartbeat or breathing stops. This means no chest compressions, no electric shock, no breathing tube insertion, and no medication injected into your heart. In New York, there are two types:
A hospital DNR order applies when you are admitted to a health care facility such as a hospital, nursing home, or mental hygiene facility. The order is recorded in your medical chart and is honored by emergency personnel during transfers. If you want to make your DNR wishes known before being admitted, you can include them in your health care proxy, your living will, or on the MOLST form. You can also consent verbally or in writing to a DNR order while in the facility.
A non-hospital DNR order applies when you are at home or in a community setting. It must be recorded on the state-specific form DOH-3474 and signed by your doctor. You can also wear a DNR bracelet once you have this order in place, and emergency medical personnel are required by law to recognize the standard bracelet. Many of my elderly clients prefer the bracelet option because it provides visual confirmation that they do not need to carry any paper documentation.
It is worth noting that a DNR order does not prevent all medical treatment. It only prevents CPR when your heartbeat or breathing stops. You will still receive regular medical care, medication, oxygen therapy, and treatment for pain and symptoms.
4. Medical Orders for Life-Sustaining Treatment (MOLST)
The MOLST form is a newer option in New York that has gained popularity in recent years. It allows your doctor to record your preferences regarding CPR, mechanical ventilation, and other life-sustaining treatments on a single form as a physician order. The form, DOH-5003, must be completed by a health care professional and signed by a physician licensed in New York.
MOLST is designed for patients with serious illness or a life expectancy of less than one year. It translates your advance directive wishes into active medical orders that travel with you from one care setting to another. Unlike a health care proxy or living will that simply states your preferences, the MOLST form becomes part of your medical record immediately. If you are transferred from a hospital to a nursing home, the MOLST form moves with your chart so every provider knows your treatment preferences from the moment you arrive. It should not replace a health care proxy or living will but works alongside them as an active physician order.
One practical note from my experience: clients often ask whether they need a MOLST form if they already have a health care proxy. The answer depends on your health status. If you are generally healthy and planning for the future, a health care proxy and living will are sufficient. If you currently have a serious or chronic condition, adding a MOLST form ensures your treatment preferences are immediately visible to every doctor who sees you.
How to Execute a Health Care Proxy in New York
Signing a health care proxy in New York requires two adult witnesses. Both witnesses must watch you sign the document and confirm that you appeared to sign willingly. Neither your appointed health care agent nor your alternate agent can serve as a witness. Notarization is not legally required for a health care proxy, though many people choose to notarize it anyway.
The minimum requirements for a valid health care proxy form include your name as the principal, the name of your appointed health care agent, your statement that you intend the agent to have authority to make health care decisions on your behalf, your signature and date, and the signatures and dates of two witnesses.
Optional sections include naming an alternate agent, stating your treatment wishes or placing limitations on the agent’s authority, expressing your wishes about organ or tissue donation, and setting an expiration date or trigger condition for the proxy to end.
Choosing Your Health Care Agent
Selecting your health care agent is perhaps the most important decision in the entire process. You can appoint any competent adult – your spouse, a partner, an adult child, a relative, a close friend, or even a lawyer. The person does not need to live in the same city or state as you, though it is often practical to choose someone nearby who can be present during a medical crisis.
There are a few restrictions. You cannot appoint your doctor as your health care agent unless that doctor is your spouse or relative. You cannot appoint an operator, administrator, or employee of the hospital or nursing home where you are currently admitted unless they are a relative or you appointed them before admission.
Consider whether the person you want to name is comfortable having this responsibility and is capable of standing up for your wishes even when under pressure. This is not about choosing the person who agrees with everything you want – it is about choosing someone who will carry out your wishes regardless of their own feelings.
Why Notarization Matters (Even When It Is Optional)
New York law does not require you to notarize a health care proxy. Two witnesses are enough. So why do I always recommend it to my clients?
First, notarization confirms your identity through formal government ID verification. While witnesses can vouch for your signature, a notary performs credential analysis and records the specific identification document used. This adds a layer of authenticity that hospitals and nursing homes appreciate.
Second, notarization prevents future family disputes about whether the document was signed willingly and by the correct person. I have seen families argue over whose copy of a witnessed-but-unnotarized proxy was the valid one. A notarized document has a certificate of notarization with a notarial seal, a journal entry, and an audio-video recording in the case of remote online notarization.
Third, notarized advance directives are more easily recognized across state lines. If you divide your time between New York and another state, or if you travel frequently, a notarized document carries more weight in jurisdictions that do require notarization for advance directives.
The cost is minimal, especially through RON services where the standard New York fee for an electronic notarial act is $25 per notarization. For the peace of mind it provides, most clients find it absolutely worth it.
Remote Online Notarization for Advance Directives
Remote online notarization, commonly known as RON, has transformed how New Yorkers execute legal documents. Instead of scheduling an in-person meeting and traveling to a notary’s office, you can complete the entire process from home via a secure audio-video platform.
What Is Remote Online Notarization?
RON is authorized under New York Executive Law Section 135-c. It allows a commissioned notary public who is physically located in New York State to perform a notarial act by appearing with the signer through a live two-way audio-video communication platform. The signer can be anywhere in the world – they do not need to be in New York, or even in the United States. I have notarized documents for clients in Florida, California, Canada, and even the United Kingdom. As long as the document relates to a New York matter or involves United States property or transactions, the RON session is perfectly valid.
The RON session is recorded and retained in the notary’s journal for a minimum of ten years. The notary performs credential analysis on your government-issued photo ID and, where applicable, also performs identity verification through knowledge-based questioning. The third-party video platform must meet the NIST Identity Assurance Level 2 standard, ensuring secure and reliable communication throughout the session.
How the RON Process Works for Advance Directives
Here is what a typical advance directive RON session looks like from start to finish. You schedule an appointment with the notary and receive a link to the audio-video platform along with instructions on how to upload your document. At the scheduled time, you connect to the session and display your government-issued photo ID to the camera. The notary verifies your identity, confirms that you understand the document you are signing, and witnesses your signature electronically on the screen. After the session ends, the notary applies their electronic notarial seal, records the act in their permanent journal, and sends you the fully executed document by email.
The entire process takes about fifteen to twenty minutes for a single document. If you are executing a full advance directive package – health care proxy, living will, and even a durable power of attorney – the session might run twenty-five to thirty-five minutes.
RON Benefits for Elderly and Homebound Clients
Remote online notarization is especially valuable for elderly clients and people with mobility challenges. There is no need to arrange transportation, navigate unfamiliar buildings, or deal with the stress of scheduling around medical appointments. Many of my clients are parents of elderly individuals who live in assisted living facilities or who have limited mobility. The RON platform allows them to sign their advance directives from their living room, their hospital room, or even their bedroom while their family member sits nearby offering support.
Technical Requirements
For a smooth RON session, you will need a device with a working camera and microphone – a smartphone, tablet, laptop, or desktop computer all work perfectly. A stable internet connection is essential. If you have slow internet, consider switching to a wired connection or using your phone as a cellular hotspot. The notary’s platform must meet the NIST Identity Assurance Level 2 standard, and reputable platforms like Notary Edge, SureOne, and Doc Writer all satisfy New York State requirements.
A relatively recent development is worth mentioning. New York has updated its health care proxy law to specifically allow remote witnessing through audio-visual platforms such as Zoom or FaceTime. Under this amendment, the principal must show valid photo ID if not personally known to the remote witness, the completed document must be sent electronically within 24 hours, and the remote witness must sign the received copy and return it. This means that even if you choose not to get your health care proxy notarized, you can still legally execute it remotely with witnesses joining via video call. Combined with RON notarization, this gives you multiple flexible options for getting your advance directives signed without leaving home.
Common Mistakes and How to Avoid Them
In my years notarizing these documents, I have noticed several recurring mistakes that clients make when preparing their advance directives.
Confusing a Health Care Proxy with a Power of Attorney
A health care proxy and a durable power of attorney are two separate documents under New York law. A health care proxy appoints someone to make medical decisions for you. A power of attorney appoints someone to handle your financial and property matters. The New York Health Care Proxy Law specifically requires you to use a health care proxy form to appoint your medical agent. You cannot combine the two roles into one document, though you can name the same person as your agent for both. In fact, since the 2021 statutory update, all New York Powers of Attorney require notarization plus two witnesses, while a health care proxy only requires two witnesses with notarization being optional.
Waiting Too Long to Sign
I see clients wait until a parent is already in the hospital or showing signs of cognitive decline before attempting to sign the advance directive. The document is only valid if the principal is mentally competent at the time of signing. If your parent has been diagnosed with dementia or Alzheimer’s, I recommend obtaining a doctor’s letter confirming their mental competence at the time of execution. This small step prevents banks and hospitals from challenging the document later.
Skipping the Conversation with Your Agent
Signing the form is only half the job. You must have a real conversation with your appointed health care agent about your wishes. Tell them specifically what treatments you do and do not want. Share your concerns, your values, and your boundaries. An agent who knows your preferences will make decisions much more confidently under pressure.
Forgetting to Distribute Copies
After your advance directives are signed and notarized, you should make several photocopies. Keep the original in a safe but accessible place – not a safe-deposit box that requires a key. Give copies to your health care agent, your alternate agent if you named one, your close family members, your primary care doctor, and any specialist managing your condition. Under New York law, any doctor who receives a health care proxy form must arrange for a copy to be placed in your medical record.
Not Reviewing Your Documents Periodically
Advance directives are not set-and-forget documents. If your health care agent moves out of state, changes jobs, or if your own medical conditions change, you should review and possibly update your documents. You can cancel and replace a health care proxy at any time. If you divorce and your spouse was your agent, the proxy is automatically canceled by law.
The Family Health Care Decisions Act: What Happens Without a Proxy
New York has a safety net for people who never create an advance directive. The Family Health Care Decisions Act, passed in 2010, allows a surrogate decision-maker to act on your behalf if you lose capacity. The law establishes a prioritized list: first your court-appointed guardian, then your spouse, then your adult children, then your parents, then your adult siblings, and finally a close friend who is familiar with your values and preferences.
While this is helpful, there are two downsides. First, the law picks your decision-maker based on a rigid priority list that may not reflect your actual wishes. Perhaps your youngest child is the most involved in your care, but your oldest child gets priority by default. Second, the surrogate can only make decisions based on your known religious or moral beliefs or, if those are unknown, your best interests. A health care proxy gives you much more control over who decides and how they decide.
Practical Tips for Clients
Here are my top practical recommendations for anyone executing advance directives through my remote online notarization service.
Schedule enough time for the session. Rushing through an advance directive is never a good idea, especially if you are executing multiple documents. I always recommend booking a thirty-minute slot even if you think you will only need twenty minutes.
Have your government-issued photo ID ready before the session starts. A driver’s license or state ID works perfectly. A passport is also fine. Make sure the photo is clear and the ID has not expired.
Involve a family member in the session if possible. Having a family member on the call can help with technical setup and can also serve as a witness if the document requires additional witnessing beyond the notary’s role.
Ask questions. If you are unsure about a section of the form or do not understand what a particular clause means, ask the notary. While I cannot provide legal advice, I can explain what each section of the form asks you to fill in and how it typically works.
Consider the full package. Executing a health care proxy, living will, and durable power of attorney all in one RON session is efficient and cost-effective. You handle all your advance planning in a single appointment rather than scheduling three separate ones.
Discuss palliative care with your doctor. New York’s Palliative Care Information Act requires your attending health care practitioner to offer you information and counseling about palliative care and end-of-life options if you are terminally ill or have an advanced life-limiting condition. Use that information to inform what you put in your living will.
Keep digital copies stored in the cloud. In addition to physical copies, upload scanned images of your signed advance directives to a cloud storage service like Google Drive, Dropbox, or iCloud. Share the link with your health care agent so they can access the documents even if the originals are not immediately available during an emergency.
Make sure your health care agent knows where everything is. Having a document is not enough if your agent does not know it exists or where to find it during a crisis. Have a direct conversation with them and explicitly tell them where the documents are stored. Some clients use a wallet card that states their advance directive exists and lists the location of the original copy.
Frequently Asked Questions
Do I need to be a New York resident to use RON for my advance directive? No. You can be anywhere in the world. The notary must be physically located in New York State, but you can sign from a different state, another country, or even on a cruise ship with good internet.
Can I execute my advance directive while I am currently in the hospital? Absolutely. Many of my clients do this. As long as you have a device with a camera and internet access, and you are mentally competent to understand what you are signing, the process works just as easily from a hospital room.
Does my health care agent need to be present during the RON session? No, the agent does not need to be present. Only you, the principal, need to be on the audio-video call.
What happens if my internet connection drops during the session? The notary will pause the recording, resume the session once you reconnect, and document the interruption in their journal. Reputable platforms handle this gracefully with timestamps.
How long does an advance directive remain valid? It remains valid indefinitely unless you cancel it, revoke it, or include an expiration date in the document. You should review it every few years and update it if your circumstances change.
Can I change my health care agent after signing? Yes. You can revoke your current health care proxy at any time and execute a new one naming a different agent. Notify your old agent, your doctor, and anyone who holds a copy of the previous document.
Is there a fee for the remote online notarization? The standard New York State fee for a RON notarial act is $25 per notarization. Some notaries may charge additional fees for multiple documents in a single session, so ask about pricing before scheduling.
Can my health care proxy and power of attorney name the same person as agent? Yes. You can name the same trusted person to handle both your medical decisions and your financial affairs. Many clients do this for simplicity, though some prefer to split the roles between two different people they trust.
How do I cancel a DNR order? You or your health care agent can cancel a DNR at any time by telling your doctor verbally or in writing. You can also show your intention to cancel by destroying the DNR document or removing a DNR bracelet. If a surrogate wants to cancel your DNR, they must either tell your doctor in the presence of an adult witness or provide written notification to your doctor or nurse.
Plan For The Unexpected
Advance directives are one of those documents that take minutes to create but save families from hours of stress when the time comes. Whether you are planning ahead for yourself or helping an elderly parent get their affairs in order, the process is straightforward, affordable, and now more accessible than ever thanks to remote online notarization.
I encourage you to take action today. Download the free forms from the New York State Department of Health or the Attorney General’s website, have a conversation with your chosen health care agent, and schedule your RON session. Your future self and your family will be glad you did.
Remember, the goal is not to plan for the worst. The goal is to plan for the unexpected, so that when it happens, your wishes are clear, your agents are empowered, and your family can focus on what matters most – being there for you.
Disclaimer: This blog post is provided for informational purposes only and does not constitute legal advice. Laws and requirements may change over time. For specific questions about your situation, consult a qualified New York State attorney who specializes in estate planning or elder law.