This form allows you to designate a surrogate to make health care decisions for you if you are determined to be incapacitated to provide informed consent for medical treatment and surgical and diagnostic procedures.
Jacksonville Florida Health Care Proxy - Designation of Health Care Surrogate - Statutory Form
State:
Florida
City:
Jacksonville
Control #:
FL-P020
Format:
Word;
Rich Text
Instant download
Description
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How to fill out Florida Health Care Proxy - Designation Of Health Care Surrogate - Statutory Form?
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FAQ
If a person is unable to make decisions about personal health care, some other person or people must provide direction in decision making. The general term for such person is surrogate decision maker.
A health care proxy may also be called a durable medical power of attorney or an appointment of a health care agent or health care surrogate. Naming a proxy can help ensure that you get the health care you prefer in the event that you cannot communicate your wishes.
A designation of health care surrogate is an incapacity planning document naming your health care advocate. This, along with your living will, is known as an advance directive.
Does a Designation of Health Care Surrogate Need to be Notarized? No, you do not need to notarize your designation, but you will need to sign the designation before two witnesses and have the witnesses attest to your signature. At least one of the witnesses must not be a blood relative.
The designation must be signed by the principal in the presence of two witness who must also sign the document in the presence of the principal; The witnesses must be at least 18 years old; The surrogate cannot be a witness; and. At least one of the witness must not be the principal's spouse or blood relative.
(1) A written document designating a surrogate to make health care decisions for a principal or receive health information on behalf of a principal, or both, shall be signed by the principal in the presence of two subscribing adult witnesses.
What is a Health Care Proxy and how is it Different from a Health Care Surrogate? A health care proxy is used in Florida when someone is incapacitated and has not created a designation of health care surrogate or the designated surrogate is unable or unwilling to act.
A Health Care Proxy is also known as a Health Care Surrogate, Agent, Attorney-in-Fact or other similar terms. Here, we'll use the terms Healthcare Surrogate, Proxy and Agent interchangeably. A Health Care Proxy makes medical decisions for you if you can't make them on your own for any reason.