Section 201D:4 - Duties of health care proxyThe health care proxy shall:
(i) identify the principal and the health care agent;(ii) indicate that the principal intends the agent to have authority to make health care decisions on the principal's behalf;(iii) describe the limitation, if any, that the principal intends to impose upon the agent's authority; and(iv) indicate that the agent's authority shall become effective if it is determined pursuant to section six that the principal lacks capacity to make health care decisions.Mass. Gen. Laws ch. 201D, § 4