Create Document
Adobe PDF
To exercise this document accordingly, the principal must supply the name & address of their attorney-in-fact (and of a successor agent if they wish), instructions for their healthcare priorities, and their signature along with the endorsement of two (2) witnesses.
Laws
Statutes – § 765.201 – § 765.205
Definition – Surrogate § 765.101(21)
Signing Requirements – Must be signed in the presence of two (2) witnesses, one (1) of whom is neither a spouse nor a blood relative of the principal (§ 765.202).
Other Versions (4)
Florida Medical Power of Attorney – Version 1
Download: Adobe PDF
Florida Medical Association Version
Download: Adobe PDF
Florida Medical Clinic Version
Download: Adobe PDF
Naples Community Hospital Version
Download: Adobe PDF
Additional Resources
- Health First – Living Will & Health Care Surrogate FAQ
- State of Florida – Designation of Health Care Surrogate Instructions
Related Forms (9)
- Advance Directive (Medical POA & Living Will)
- Designation of Health Care Surrogate for Minor
- Durable (Financial) Power of Attorney
- DNR (Do Not Resuscitate) Order
- Living Will
- Mental Health Advance Directive
- POLST Form
- Uniform Donor Form
- Wallet Card for Advance Directives
Advance Directive (Medical POA & Living Will)
Download: Adobe PDF
Designation of Health Care Surrogate for Minor (§ 765.2035, § 765.2038)
Download: Adobe PDF
DNR (Do Not Resuscitate) Order (multilingual version also available in Spanish & Haitian Creole)
Download: Adobe PDF
Durable (Financial) Power of Attorney
Download: Adobe PDF, MS Word (.docx)
Download: Adobe PDF
Mental Health Advance Directive
Download: Adobe PDF
Download: Adobe PDF
Download: Adobe PDF
Wallet Card for Advance Directives
Download: Adobe PDF
Comments