Free Florida Medical Power of Attorney Form

Florida calls this document a designation of health care surrogate. It names a surrogate to make health care decisions for you, to receive your health information, or both, under Chapter 765 of the Florida Statutes.

Florida Statutes § 765.202 covers how the designation works.

Sign in Front of Two Adult Witnesses

You sign the written designation while two adult witnesses watch. If you cannot sign, you may direct another person to sign your name in the witnesses’ presence.

Who Can Be a Witness

Your surrogate cannot act as a witness. At least one of your two witnesses must be neither your spouse nor a blood relative.

Give Your Surrogate an Exact Copy

Florida requires that your surrogate receive an exact copy of the signed document. Handing it over on signing day is the easiest way to take care of this.

Name an Alternate Explicitly

You can name an alternate surrogate, but the designation must be explicit. Skipping an alternate does not invalidate the document. If neither is available, the health care facility may seek a proxy under another part of the law.

It Lasts Until You Revoke It

Unless your document sets an end date, the designation stays in effect until you revoke it. A signed Florida medical power of attorney also creates a rebuttable presumption of clear and convincing evidence that you chose that surrogate.

Yes, if you say so in the document. Florida lets you stipulate that your surrogate can receive your health information, make health care decisions, or both, immediately. No finding of incapacity is needed first.

On a Florida medical power of attorney, the state’s suggested form handles this with two boxes to initial. One makes access to your health information immediate. The other makes decision-making authority immediate. If you initial neither, your surrogate’s authority begins when your primary physician determines you cannot make your own health care decisions.

Use these steps to finish your Florida medical power of attorney form:

1. Name your health care surrogate and, explicitly, an alternate.
2. Decide whether to initial either box for immediate authority.
3. Add any instructions or limits on your surrogate’s decisions.
4. Sign in front of two adult witnesses, making sure one is not your spouse or a blood relative.
5. Give your surrogate an exact copy right away.
6. Share copies with your doctors and keep the original somewhere easy to find.

Florida’s suggested form in § 765.203 is optional. It lists your surrogate and alternate with their contact details, your health care instructions, and the two initial boxes for immediate authority.

The form also restates your revocation options under Florida law. While you still have capacity, you can revoke or amend by:

• Signing a written, dated instrument
• Physically destroying the designation, or having someone do it in your presence at your direction
• Verbally expressing your intent to revoke or amend
• Signing a new designation that is materially different