In most states, a health care proxy does not need to be notarized — signing in front of two qualified adult witnesses is enough. A small number of states, including North Carolina and West Virginia, do require notarization for the document to be legally valid, and a few others require it for a medical power of attorney specifically. Because each state writes its own execution rules, the right answer depends on where you sign.
States That Require Notarization
In a handful of states, skipping the notary step means the document may be treated as legally ineffective even if witnesses were present.
- North Carolina. A health care power of attorney must be signed in the presence of two witnesses and acknowledged before a notary public.1North Carolina General Assembly. North Carolina General Statutes 32A-25.1
- West Virginia. A medical power of attorney must be signed before at least two witnesses who are 18 or older, and the witness signatures must then be acknowledged before a notary public.2West Virginia Legislature. West Virginia Code 16-30-4 – Executing a Living Will, Medical Power of Attorney, or Combined Medical Power of Attorney and Living Will
Other states that require notarization for a medical power of attorney include Florida, Iowa, Kansas, and Kentucky. The notary verifies the identity of the person signing and confirms that the signature appears voluntary. This adds a layer of fraud protection, but it also means you need to plan ahead. A proxy signed during a sudden hospital admission may not be valid if no notary is available.
If a proxy is declared invalid because it was not properly notarized, a court may need to appoint a guardian to make medical decisions on your behalf. Guardianship proceedings take time, cost thousands of dollars in legal and court fees, and may put someone you would not have chosen in charge of your care.
Witnesses as the Default Alternative
Most states let you execute a health care proxy by signing it in front of two adult witnesses instead of using a notary. This is the more common approach and is designed so that people can finalize these documents quickly, including in hospital settings where a notary may not be readily available.
New York requires only that a competent adult sign the proxy in the presence of two adult witnesses, who must also sign the document.3New York State Senate. New York Public Health Law 2981 – Appointment of Health Care Agent California gives residents a choice: you can have your advance directive acknowledged before a notary, or have it signed by at least two qualified witnesses.4California Legislative Information. California Probate Code 4673
The witnesses’ job is straightforward. They watch you sign the document and confirm that you appear to understand what you are doing and are not being pressured. By adding their own signatures, they create a contemporaneous record that you executed the proxy voluntarily and with the mental capacity to do so.
Remote Witnessing
Some states now allow witnesses to observe the signing through audio-video technology rather than being in the same room. New York permits remote witnessing as long as the signer shows valid photo identification on camera, the video platform allows direct interaction, and the remote witness receives a copy of the signed proxy within 24 hours to countersign.3New York State Senate. New York Public Health Law 2981 – Appointment of Health Care Agent Not every state has adopted remote witnessing, so check your state’s current rules before relying on a video call.
Electronic Documents May Still Require a Notary
California allows electronic advance health care directives, but with a notable restriction: electronic versions require notarization rather than just witnesses, and any digital signature must meet specific technical standards for verification and security.4California Legislative Information. California Probate Code 4673 If you plan to create and store your proxy electronically, confirm that your state recognizes digital execution and understand any additional requirements that come with it.
Who Cannot Serve as a Witness
States restrict who can witness your proxy to prevent conflicts of interest. The exact list varies, but the most common exclusions include:
- Your health care agent or alternate agent.5Oregon State Legislature. Oregon Revised Statute 127.515 – Execution; Witnesses; Out-of-State Execution
- Your attending physician or health care provider.5Oregon State Legislature. Oregon Revised Statute 127.515 – Execution; Witnesses; Out-of-State Execution
- Owners or operators of the health care facility where you are a patient.
- Employees of that facility, in many states.
- People with a financial interest in your estate, including relatives or heirs in some states.
If a disqualified person signs as a witness, the proxy can be challenged and potentially invalidated in court. That holds even in states where witnessing alone is otherwise sufficient.
Extra Rules for Nursing Home Residents
If you live in a skilled nursing facility, some states impose additional witness requirements beyond what applies to the general population. California requires that when a nursing home resident signs an advance health care directive, a patient advocate or ombudsman designated by the Department of Aging must sign the directive as a witness, either as one of the two required witnesses or in addition to notarization.6California Legislative Information. California Probate Code 4675 Without the ombudsman’s signature, the directive is not effective. If you or a family member is signing a proxy while in long-term care, ask the facility’s social worker or patient advocate whether your state has a similar requirement.
How to Execute the Document Correctly
The process is not complicated, but each step matters. Skipping one can leave you with a document that looks official but carries no legal weight.
- Choose an agent you trust to follow your wishes. Name an alternate in case your first choice is unavailable.
- Use your state’s official form where possible. Most states publish one through their department of health, which is the simplest way to meet formatting requirements.
- Sign in front of your witnesses or notary, with all parties present at the same time, whether physically or through audio-video technology where that is allowed.
- Have witnesses or the notary sign immediately after you do. Delays between signatures can create grounds for a legal challenge.
Store the original somewhere secure but accessible. A safe deposit box your agent cannot reach in an emergency defeats the purpose. Give copies to your agent, your alternate, and your primary care physician, and ask your doctor’s office or hospital to scan it into your electronic health record.
If You Live in or Travel Between Multiple States
Most states recognize health care directives from other states as long as the document was valid where it was originally signed. This is not universal. Some states honor an out-of-state proxy only to the extent it complies with their own laws, and a few states are silent on the question entirely.
The Uniform Health-Care Decisions Act, developed in 1993, was intended to standardize advance directive laws across state lines, but only a small number of states have adopted it. If you regularly spend time in more than one state, the safest approach is to execute your proxy to the strictest common standard. Getting it both witnessed and notarized, even when your home state only requires one, is a reasonable way to improve the odds it is accepted wherever you receive care.
Notary Fees
If your state requires notarization or you choose it for extra protection, the cost is modest. Most states cap notary fees by law, with maximum charges for an acknowledgment typically ranging from $2 to $25 per signature. Many notaries charge less than the legal maximum, and some banks, libraries, and hospitals offer notary services at no cost. Mobile notaries who travel to your location usually charge more, often adding a travel fee on top of the per-signature charge.