Assemblyman
Michael
Benedetto:
photo
Putting
your health
first


Restoring
health
care cuts
Delivering
Medicaid
relief

To help make your health care wishes known, a health care proxy form is provided below.


Benedetto helped deliver an on-time budget that protects our quality health care

Keeping Bronx families healthy

“The savings yielded by the cap on Medicaid should be reinvested in our city schools. This additional aid will help provide our students with a safe, modern environment where they can focus on learning.”

— Assemblyman
Michael Benedetto

The budget:

  • Rejects any attempt to make it more difficult to enroll in Family Health Plus

  • Rejects attempts to cut basic benefits like vision, dental and hospice care for Family Health Plus

  • Increases efforts to collect $20 million in rebates owed the state by pharmaceutical companies

  • Creates a preferred drug list that cuts costs, protects patients, and ensures doctors have the final say in medical decisions

  • Scales back the governor’s sick tax on nursing homes and cuts his tax on hospitals in half

Protecting care and local taxpayers

The bipartisan budget provides a property tax reduction by limiting the growth of local Medicaid costs, along with an acceleration of the state takeover of the Family Health Plus program costs, saving New York City nearly $524 million next year.

Projected Medicaid Relief for New York City


Health Care Proxy Form

***Click here for printable view.***

l)   I,

hereby appoint
(name, home address and phone number) as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise. This proxy shall take effect when and if I become unable to make my own health care decisions.

2)   Optional: Alternate Agent. If the person I appoint is unable, unwilling or unavailable to act as my health care agent, I hereby appoint:
(name, home address and telephone number) as my health care agent to make any and all health care decisions for me, except to the extent that I state otherwise.

3)     Unless I revoke it or state an expiration date or circumstances under which it will expire, this proxy shall remain in effect indefinitely. (Optional: If you want this proxy to expire, state the date or conditions here.
This proxy shall expire (specify date or conditions):

4)   Optional: I direct my health care agent to make health care decisions according to my wishes and limitations, as he or she knows or as stated below. (If you want to limit your agent’s authority to make health care decisions for you or to give specific instructions, you may state your wishes or limitations here.) I direct my health care agent to make health care decisions in accordance with the following limitations and/or instructions (attach additional pages as necessary).


In order for your agent to make health care decisions for you about artificial nutrition and hydration (nourishment and water provided by feeding tube and intravenous line), your agent must reasonably know your wishes. You can either tell your agent what your wishes are or include them in this section.

5)   Your Identification: (print) Your Name

Your Signature

Date

Your Address

6)   Optional: Organ and/or Tissue Donation
I hereby make an anatomical gift, to be effective upon my death, of: (check any that apply)

check boxAny needed organs and/or tissues
check boxThe following organs and/or tissues
check boxLimitations

If you do not state your wishes or instructions about organ and/or tissue donation on this form, it will not be taken to mean that you do not wish to make a donation or prevent a person, who is otherwise authorized by law, to consent to a donation on your behalf.

Your Signature
Date

7)   Statement by Witnesses: (Witnesses must be 18 years of age or older and cannot be the health care agent or alternate.)
I declare that the person who signed this document is personally known to me and appears to be of sound mind and acting of his or her own free will. He or she signed (or asked another to sign for him or her) this document in my presence.
Witness 1 (print) Address Date
Witness 2 (print) Address Date


photo

Making personal decisions

Whether to accept or reject medical care in an end-of-life situation is a very personal decision governed by one’s own beliefs. Should a serious accident or illness leave you unable to communicate those wishes, it is necessary to take steps to ensure that they are honored. In New York State, that means having a living will or health care proxy.

Attached is a health care proxy form that you can complete for your records. Once you complete a health care proxy, hospitals, doctors and other health care providers must follow your agent’s decisions as if they were your own.

photo

Where should I keep my proxy?

Give a copy to your agent, doctor and family members or close friends. Keep a copy with your important papers. You can contact my district office for more information.

Assemblyman Michael Benedetto

3369 E. Tremont Ave.
Bronx, NY 10461
(718) 892-2235

Back