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I would like to be the primary agent. My cousin has agreed to be the secondary agent. What happens if I am not reachable for a short period of time (ie, on a plane)? How does my cousin step in until I am available? I understand I must decline or be incapacitated, but what if I am just unreachable? Is it possible to add a letter to the proxy document outlining the arrangement? My mom has a living will, specifying only comfort care, which I think also simplifies a lot of decisions.

It may be my fault for not understanding, but I wonder if you have read the USA instructions for this document. It sounds to me as if you are translating from a different document in a different language. A ‘proxy’ is “a person who is acting in the place of someone else” – so who is the ‘person’ and who is the ‘someone else’? Is this someone you want to appoint, or your mother needs to appoint? If you ‘would LIKE to be the primary agent’, you can’t be appointing yourself, and if your mother is appointing then she chooses. Is the 'primary agent' the same as the 'proxy'? “My cousin has agreed to be the secondary agent” – but again who is appointing, you or your mother or even your cousin herself.

Get a copy of the document, and find someone who really understands the details. That will also help you to work out what should happen if you are not available.
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Reply to MargaretMcKen
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As MargaretMcKen pointed out, in the US you cannot appoint a legal proxy for someone else unless you go to court and get guardianship, and this only happens if the principal is proven to be incapacitated cognitively or a minor. I think you are referring to Power of Attorney authority. The rules for PoA can vary by state. Your Mom needs to have capacity in order to assign someone to legally act on her behalf.
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Reply to Geaton777
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If this is a POA then it is written by an attorney to say exactly what you need it to say.
If your mother is no longer capable of making these decisions then it will be somewhat more difficult and you should consult, even if by phone, with an attorney in her area.
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Reply to AlvaDeer
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You cannot appoint a healthcare proxy for your mother. She has to appoint you and the secondary. She sees a lawyer and he writes the proxy with her telling him what she wants and does not want concerning her health. The person assigned makes sure her wishes are followed when she is incompetent to make informed choices. If a heath crisis arises that is not mentioned in the proxy, then the assigned person makes the decision based on what they feel the principle would want. I really don't think you should hold health care proxy. Your too far away. Maybe cousin would be a better choice.
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Reply to JoAnn29
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