Get Health Care Surrogate Form

Filling out the Health Care Surrogate Form online is an essential step in ensuring that your health decisions are managed by someone you trust when you are unable to make them yourself. This guide will walk you through the process step by step, making it easier for you to complete the form correctly.

Follow the steps to complete the Health Care Surrogate Form online.

1. Press the ‘Get Form’ button to access the Health Care Surrogate Form and open it in your preferred editing tool.
2. Begin by entering the patient’s name in the designated field at the top of the form. Ensure the name is spelled correctly to avoid any confusion.
3. Next, input the date of birth (DOB) of the patient. This information helps verify the identity of the individual for whom the decisions will be made.
4. In the section for appointing a surrogate, decide if you wish to name a specific surrogate or if you need to follow the order of priority listed. Document the specific appointed surrogate(s) in the designated lines.
5. If there is a court-appointed guardian or an agent under a health care power of attorney, note that in the respective section as well. It is important to place a copy of these documents in the medical record.
6. Follow the order of statutory surrogates if no appointed surrogate is available. Begin with the spouse, then include any adult children, parents, domestic partners, siblings, or close friends. Ensure to note their names and any necessary contact details.
7. Once all necessary surrogates have been identified, complete the notes section if you have any relevant information to include regarding the selection process.
8. The form should then be signed by the person completing it, with the date noted. Include your title and the health provider or facility name if applicable.
9. Finally, review all entries for accuracy. Once confirmed, you may save any changes made, download, print, or share the completed form as required.

Complete your Health Care Surrogate Form online today to ensure your health care decisions are in trusted hands.