Florida Durable Power of Attorney for Health Care Form (Living Will)

Title XLIV, Chapter 765, Part I, Section 765.101-765.113 of 2015 Florida Statutes has guidelines related to issuing advanced directives to appoint a health care surrogate to take health care decision on your behalf in case you are declared incapacitated to do so. This Florida Durable Power of Attorney for Health Care Form (Living Will) has two parts offering living will and advanced directives. Please appoint a trustworthy surrogate who understands your priorities, wishes regarding health care including, and not limited to continue or withdraw life prolonging procedures. You may use this health care power of attorney form to express your wishes related to health care and these are binding on the attending physician and health care providers in Florida State.

Information about Florida Durable Health Care POA with Living Will

  • Please appoint a person as a surrogate who maintains intermittent contact and is familiar to your personal, moral, religious, and cultural beliefs.
  • Please understand the significance of the term Living Will and make your choices for life prolonging procedures. Your choices made today are binding on your physician even when you are incapacitated to make your own decision due to reasons like coma or accident.
  • The term Durable in the title of this Medical Power of Attorney indicates that this document remains in force until your death even if you are incapacitated.
  • This Living Will and Durable power of attorney is not effective during your declared pregnancy.
  • Notarization of your signature is not necessary. However, signatures of two witnesses acknowledging your signature on this form are required.

How to Fill this Florida Durable Medical Power of Attorney

Step 1: Enter your name and age in the respective spaces of the first line of the Medical POA Form.

Step 2: Enter name, relation, work and home phone number, and address of surrogate / decision maker. You may choose to appoint alternate decision makes by providing his/her name, relation, work and home phone number, and address on the succeeding lines.

Step 3: Provide additional instructions if any. Date and sign this form before two adult witnesses. Your witnesses must sign in acknowledgement of you signing this form.

Step 4: Optionally mark your choice for life prolonging procedures by signing with initials. You need to specify other conditions if you sign before the second option. Then mark your choice for providing nutrition via tubing by signing before I do or I do not option. Then provide additional instructions if any. Please date this Living Will and sign before two adult witnesses. Your witnesses must acknowledge your signature by signing on the form.

How to Revoke a Power of Attorney in Florida

This Florida Medical Durable Power of Attorney Form remains in force until your death. You may choose to issue a revocation instrument to cancel this power of attorney. However, you must notify your physician and/or health care provider immediately about the revocation, collect and destroy copies handed over to all, and prepare a new durable health care power of attorney and living will in Florida State. Optionally, you may provide an expiration death for natural termination of this power of attorney.