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Probate and Family Court forms for health care proxy

A collection of court forms related to health care proxies.

A health care proxy is a written instrument signed by one person giving another person authority to make decisions relating to healthcare in the event the person signing becomes unable to make his or her own decisions.

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Procedure for Actions filed under G.L. C. 201D (English, PDF 143.1 KB)

(7/1/14). Provides detailed information on when you can file a petition under GL c.201D, necessary forms, and how to file them in Probate and Family Court.

Petition for Special Proceeding in re: a Health Care Proxy (MPC 405) (English, PDF 969.83 KB)

For use in Probate and Family Court pursuant to G.L. c. 201D (7/1/14). This form may not display properly in your browser. Please download the form and open it using Acrobat reader.

Statement of Attending Physician filed with Petition for Special Proceeding in re: a Health Care Proxy (MPC 406) (English, PDF 1.41 MB)

(7/1/14) Used by the Probate and Family Court in a special proceeding regarding a Health Care Proxy. This Statement must be dated, and an examination must have taken place within 30 days prior to filing. This form may not display in your browser. Please download the form and open it using Acrobat reader.

Decree on Special Proceeding re: a Health Care Proxy (MPC 793) 

For use in Probate and Family Court proceedings related to health care proxies. Revised 7/1/14. This form is also available in Portuguese and Spanish. Click the link above to access the translations.

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