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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
- 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
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