Florida Medical Power of Attorney Form

Downloads: 2,525

The Florida Medical Power of Attorney, or as the state calls it, the “Designation of Health Care Surrogate”, is the assignment of powers to another individual that enables them to make medical judgment calls on the behalf of the principal. This only goes into effect if the assignor loses their mental capacity and is unable to voice their preferred course of action. 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 health care 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

Related Forms (9)

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)

 

 

 


Living Will

Download: Adobe PDF

 

 

 


Mental Health Advance Directive

Download: Adobe PDF

 

 

 


POLST Form

Download: Adobe PDF

 

 

 


Uniform Donor Form

Download: Adobe PDF

 

 

 


Wallet Card for Advance Directives

Download: Adobe PDF