your health


drug costs

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

DelMonte - fighting to protect our well-being
Improving access and affordability of health care

Assemblywoman DelMonte:

  • Sponsored a measure that requires drug retail price lists to be posted on a central Web site to make comparison shopping faster and easier (Ch. 293 of 2005)
  • Secured $400,000 to build a state-of-the-art heart facility at Niagara Falls Memorial Medical Center
Keeping patients safe and informed

The Centers for Disease Control and Prevention estimates that 90,000 infection-related deaths occur each year.

Assemblywoman DelMonte sponsored a new law, signed by the governor, that requires hospitals to publicly disclose hospital-acquired infection rates (Ch. 284 of 2005). The measure will help keep patients safe and promote improvements throughout the health care industry.

Cracking down on home loan scams

She also supported the Home Equity Theft Prevention Act, which protects homeowners from scams that result in the loss of their homes and the equity they have built up (A.7667-A).

Protecting property taxpayers

The bipartisan budget protects property taxpayers by limiting the growth of local Medicaid costs, along with an acceleration of the state takeover of the Family Health Plus program costs, saving Niagara County taxpayers $5.5 million next year. The budget also:

  • 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

Projected Niagara County Medicaid savings
2006 $5.5 million
2007 $12 million
2008 $23.1 million

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


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

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


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.

After you sign your proxy

Give a copy to your agent, doctor, attorney and family members or close friends. Keep a copy with your important papers. You can contact my district office for more information. Do not put it in a location where no one else can access it, like a safe deposit box. Be sure to bring a copy with you if you are admitted to the hospital, even for minor or out-patient surgery.


1700 Pine Avenue
Niagara Falls, NY 14301