Florida Medical Power of Attorney (POA) Form

Florida Health Care Surrogate (HCS), which might be known as Advanced Directive, or Medical Power of Attorney, is a document that makes the principal’s designation of an individual to make end-of-life treatment decisions on his or her behalf legitimate. It is highly advisable to appoint your surrogate a person you trust and know well because he or she will be responsible for giving instructions (including, but not limited to withholding or withdrawal of life-prolonging procedures) to your attending doctor when you become incapacitated or unable due to any other circumstances to make sound choices. The medical power of attorney form is often followed by the Living Will, where an adult may express his or her wishes concerning the end-of-life treatment directly to the medical staff. You may opt for completing both documents or choose the one you consider appropriate.

The HCS form does not need to be notarized, but it is obligatory to have two adult witnesses present during the signing of the document.

Florida power of attorney forms – find out more about powers of attorney that can be used for different assets in the State of Florida.

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Florida Medical POA Laws and Requirements

In Florida, the Medical Power of Attorney (also known as Designation of Health Care Surrogate) is regulated by ss. 765.201-765.205 of the State Law.

It is required that the principal (and the surrogate and the witnesses) have reached the age of 18. All of them have to sign the document willfully, the sound of mind, and under no influence. Pay attention: if the principal is not able to provide the signature, he or she may direct another individual to do so in the presence of witnesses. Only one of the people witnessing the document can be the principal’s spouse or relative, whereas the other cannot.

According to 765.202 (3) of the Florida State Law, one may designate an alternative surrogate who will become in charge of making decisions about the principal’s medical care in case the original surrogate is unwilling or unable to act as the principal’s agent.

The surrogate should exhibit special care and concern about the principal and consult medical personnel about withdrawing or withholding only those procedures that were either indicated by the principal in advance or, if there are no written directives, opt for that type of treatment that is believed to be best for the principal.

In Florida, if the principal, being capable of communicating and making choices about his or her healthcare treatment, for any reason decides to revoke the medical power of attorney, he or she is supposed to immediately talk to the attending physician and destroy the document. Otherwise, the HCS form will remain valid and effective until the principal’s death.

Make sure you have provided the following people with a signed copy of the document:

  • The Surrogate
  • Members of the Family
  • Close Friends
  • Family Physician (Attending Physician)
  • Your Nursing Home (if appropriate)
  • The Clergy (if appropriate)

Florida Medical Power of Attorney Form Details

Document Name Florida Medical Power of Attorney Form
State Form Name Florida Durable Power of Attorney for Health Care
State Laws Florida Statutes, Sections 765.101 to 765.205
Signing Requirements Two Witnesses
Who Can’t Be the Agent? Section 765.202
Who Can’t Be the Witness? Section 765.202(2)
Avg. Time to Fill Out 8 minutes
# of Fillable Fields 21
Available Formats Adobe PDF

Filling Out the Surrogate Designation Form

Be very careful while submitting the Florida HCS Form. You will find a simple set of instructions leading you through the document’s completion below:

  • Obtain the Template

The official document may be found linked above. In order to get a personalized form, you can use our form-building software by clicking the “Create My Document” button.

  • Provide Principal’s Data

Begin completing the form with the full name of the principal, stating that he or she initiated the document’s completion, expecting an event of medical coma or incapacitation.
Principal's data part of a Florida medical power of attorney document

  • Designate the Attorney-in-fact (surrogate)

Continue by naming the chosen agent, establishing your relationship, and entering two of his or her phone numbers (work and home). Then, provide the complete address of your attorney-in-fact.
Attorney designation section of mpoa for Florida

  • Indicate an Alternative Surrogate

It is recommended but not obligatory to designate an alternative agent who will perform the duties, presuming that the original agent may happen to be unable (or unwilling) to act as your legal attorney-in-fact.
Alternative surrogate indication of a Florida medical power of attorney form

  • Submit Additional Instructions

There also exists an option to grant your surrogate special powers not described in the document, as well as limit some if you wish so. If you want to express your preferences, expecting a specific scenario, enter your directives herein, too.
Part for additional instructions of a Florida medical power of attorney

  • Witness the Document

Two witnesses should sign the document and indicate the date, affirming that it has been created voluntarily and under no pressure.

If you have made certain decisions upon your end-of-life treatment and anatomical gifts, follow up with completing the Living Will, which will support your physician(s) and other people with your choices regarding the use of life-prolonging procedures. Keep in mind that this document will have no force if you are pregnant.
Document witnessing part of a mpoa for Florida

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Other Florida Forms

Some other popular Florida templates are available for download on FormsPal and can be customized in our simple document builder.

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Published: Nov 19, 2020