Free Florida Medical Power of Attorney Form

Updated: Nov 9, 2026

Need a different document? Browse all our Florida power of attorney forms, or read about the medical power of attorney form in general.

What Is a Florida Medical Power of Attorney?

A Florida medical power of attorney is a written designation of a health care surrogate: the principal names one adult to make health care decisions and receive health information if the principal cannot make those decisions personally. Florida's statutes call the document a designation of health care surrogate, Fla. Stat. § 765.203.

The document goes by several names in searches and on forms:

• Medical power of attorney, or health care power of attorney (HCPOA)
• Designation of health care surrogate, the term in the Florida suggested form
• Durable power of attorney for medical care, or DPOA-HC

The principal is the person who signs. The surrogate, called the agent in the FormsPal template, speaks for the principal when the principal cannot speak for themselves. The template adds an advance directive, a statement of wishes about end-of-life care, so the surrogate's choices can match the principal's.

Florida Medical Power of Attorney Requirements

The surrogate designation meets Florida's signing rule when the principal signs it in the presence of two subscribing adult witnesses, Fla. Stat. § 765.202. The same section limits who may witness and sets how long the designation lasts.

Two Adult Witnesses

The witness rule of Fla. Stat. § 765.202 asks for two adults who watch the principal sign and then sign the document themselves. The statute puts it this way.

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.

Who Cannot Witness

The witness limits of Fla. Stat. § 765.202 rule out two kinds of signers:

• The person designated as surrogate shall not act as witness to the signing of the document.
• At least one witness shall be neither the principal's spouse nor a blood relative.

A spouse or a relative may still sign as the second witness, as long as the other witness is neither.

Is Notarization Required?

The signing rule of Fla. Stat. § 765.202 names two subscribing adult witnesses and does not mention a notary. The FormsPal template still prints a notary acknowledgment page. A Florida financial power of attorney under chapter 709 is different: it must be signed by the principal and two subscribing witnesses and be acknowledged before a notary public, Fla. Stat. § 709.2105.

Form Details at a Glance

What a Health Care Surrogate Can Decide

The Florida suggested form lets the principal give the surrogate authority to receive health information and to make all health care decisions, each power marked by the principal's initials, Fla. Stat. § 765.203. The form lists these decision powers:

• Provide informed consent, refusal of consent or withdrawal of consent to any and all health care, including life-prolonging procedures.
• Apply for private, public, government or veterans' benefits to pay for health care.
• Access the health information the surrogate reasonably needs to decide and to apply for benefits.
• Decide to make an anatomical gift under part V of chapter 765.

You may also designate an alternate surrogate in the same document, as long as the designation is explicit.^[1.3]

How the Surrogate Decides

Under section 765.205, your surrogate must consult promptly with appropriate health care providers to provide informed consent. The surrogate may make only the health care decisions the surrogate believes you would have made under the circumstances if you were able to make them. If there is no indication of what you would have chosen, the surrogate may consider your best interest in deciding that proposed treatments are to be withheld or that current treatments are to be withdrawn.^[3.1]

Under section 765.113, your surrogate may not consent to withholding or withdrawing life-prolonging procedures from you while you are pregnant and before viability, unless you have expressly delegated that authority to your surrogate in writing or the surrogate has sought and received court approval.^[4.1]

The suggested form also keeps the principal in charge while able: if the principal has capacity, the principal's own spoken or written decisions supersede the surrogate's conflicting ones, as the form text of Fla. Stat. § 765.203 states.

When It Takes Effect and How Long It Lasts

The surrogate designation stays in effect until the principal revokes it, unless the document states a time of termination, Fla. Stat. 765.202(7). When the surrogate's authority starts depends on the wording the principal chooses.

When the Surrogate's Authority Starts

In the suggested form, the surrogate's authority becomes effective when the primary physician determines the principal cannot make health care decisions, unless the principal initials a box that makes it take effect immediately, Fla. Stat. § 765.203. The form has two such boxes: one for receiving health information and one for making health care decisions.

The FormsPal template words this differently. It says the agent's powers take effect when your treating physician certifies in writing that you lack the capacity to make informed health care decisions.

How to Revoke or Amend It

A competent principal may amend or revoke an advance directive at any time.^[2.1] The notice printed in the suggested form of Fla. Stat. § 765.203 lists four ways to revoke or amend while the principal keeps capacity:

1. Sign a written and dated paper that states the intent to amend or revoke.
2. Destroy the designation, personally or through another person in the principal's presence and at the principal's direction.
3. Say aloud the intention to amend or revoke.
4. Sign a new designation that is materially different.

Tell the surrogate and the doctor about any change, so nobody acts on the old document.

Florida Medical Power of Attorney Form PDF

The Florida medical power of attorney PDF can be any written designation that meets the signing rule: a designation may, but need not be, in the suggested form of Fla. Stat. § 765.203. The suggested form, titled Designation of Health Care Surrogate, has lines for the surrogate, an alternate, the powers, the principal's signature and two witnesses.

You can also download the Designation of Health Care Surrogate PDF for Florida, which is a separate form from the FormsPal template on this page.

The FormsPal template is a longer document with an advance directive. Either form needs the same signing: two subscribing adult witnesses, Fla. Stat. § 765.202.

What the Template Covers

The template, titled Florida Medical Power of Attorney with Advance Directive, has nine pages in three numbered parts, a notary acknowledgment page and a page for the witnesses. What each part says comes from the printed text of the template, not from Florida law. Review all of it before you sign.

• Part I, Power of Attorney for Health Care. You name your agent here, with the agent's phone and email, and you may name one alternate agent. A list of powers follows, lettered A to J, covering consent to medical care, access to medical information, pain relief, disposition of remains and personal care.
• Effective date and HIPAA release. The template says the agent's powers take effect when your treating physician certifies in writing that you lack the capacity to make informed health care decisions. It also contains a HIPAA release, so your agent can see your medical records.
• Part II, Advance Health Care Directive. This part states your wishes about end-of-life care and about relief from pain. It is a serious statement, so read the printed wording closely.
• Part III, General Provisions. These are standard terms for the whole document. The date and signature lines come right after them on page 6.
• Acknowledgment and witnesses. Page 7 is a block with the county, the date, the officer's name and title, and a signature and seal. Page 9 has a block for each of two witnesses.

If your agent is unable to act, the template says one document must be attached to it. Examples are a signed resignation, a physician's statement, a court order or a death certificate. Part III also says that signing revokes your earlier powers of attorney for health care, living wills and directives to physicians.

If you want to keep one of those documents, ask a lawyer before you sign.

How to Fill Out the Florida Medical Power of Attorney

The template has 29 fillable fields, and the six steps below follow it from page 1 to page 9. Each step names the part of the template it covers.

The screenshots under each step show the FormsPal template filled with sample entries in blue, so you can see where each answer goes. The names, addresses, dates and amounts are examples only.

1. Enter the principal and the agent. On page 1, in paragraph 1 of Part I, type your name and address as the principal. Then enter the name and address of the person you appoint as your agent. This person is your health care surrogate.

   

2. Add contact details and an alternate agent. Still on page 1, enter the agent's phone, email and alternative contact line. In the ALTERNATE AGENT paragraph, repeat the first agent's name, then add the alternate's name, address, phone, email and alternative contact. Leave the alternate lines blank if you name no alternate.

   

3. Date and sign on page 6. Read the powers list and Parts II and III first, since they are preprinted. On page 6, enter the date, sign above the word signature and print your name above the words printed name. Sign only when both adult witnesses are with you, Fla. Stat. § 765.202.

   

4. Have the notary complete the acknowledgment. Page 7 is the acknowledgment block. The notary fills in the county, the date, their own name and title, and your name as the person who appeared. This page is part of the printed template, so ask a lawyer if you are unsure whether you need it.

   

5. Get the notary's signature and seal. Sign before the notary in the acknowledgment on page 7. The notary then signs on the Signature line and adds the official seal.

   

6. Have both witnesses sign. On page 9, each of the two witnesses fills in a signature, a printed name, an address and a date in their own block, Witness 1 and Witness 2. Pick witnesses only if they meet Fla. Stat. § 765.202: not the surrogate, and at least one neither your spouse nor a blood relative.

   

How to Sign and Use Your Medical Power of Attorney

A signed medical power of attorney works only if the right people know about it, so the signing day and the copies matter as much as the blanks. The steps below follow the witness rules of Fla. Stat. § 765.202 when they apply to the signing.

1. Read all nine pages, and check that Part II matches your wishes.
2. Note that Part III revokes earlier health care powers of attorney, living wills and directives to physicians.
3. Choose two adult witnesses who meet the witness limits.
4. Sign in the presence of both witnesses, then have each witness complete a block on page 9.
5. Give signed copies to your surrogate, your family physician and, if appropriate, your nursing home or clergy.
6. Keep the original in a safe place where your surrogate can find it.

Questions to Settle Before You Sign

A medical power of attorney works best when the people involved know what you want. These questions are common practice, not legal requirements. Decide your answers first, then talk them over with your surrogate and your doctor.

• Does the person you have in mind agree to serve as your surrogate?
• Would you like to name an alternate, in case your first choice is unable to act?
• Does your surrogate know your wishes about treatment, so the choices they make match yours?
• Have you told your family who your surrogate is, so nobody is surprised later?
• Who will hold the original, and who will get copies?

The FormsPal template has no block for extra instructions. Your wishes about end-of-life care are printed in Part II. If you want something different there, ask a lawyer for advice before you sign.

Medical Power of Attorney vs Durable Power of Attorney in Florida

A medical power of attorney covers health care decisions, while a durable power of attorney under chapter 709 is mainly used for money and property but can also give an agent health care authority, Fla. Stat. § 709.2109. The two documents follow different statutes and different signing rules.

• A chapter 709 power of attorney is durable only if it contains the words of Fla. Stat. § 709.2104, or similar words showing the authority continues despite the principal's later incapacity.
• The suggested surrogate form states that the designation is not affected by the principal's later incapacity except as chapter 765 provides, Fla. Stat. § 765.203.
• If the principal has signed a health care advance directive naming a surrogate and it conflicts with a power of attorney, the directive controls unless the power of attorney is later executed and expressly states otherwise, Fla. Stat. § 709.2109.
• Unless a court orders otherwise, a proceeding to determine incapacity does not affect an agent's authority to make health care decisions, Fla. Stat. § 709.2109.

For money and property decisions, see our Florida durable power of attorney page or our Florida general power of attorney page.

Common Mistakes to Avoid

Most problems with a medical power of attorney come from skipped signing steps, not from the blanks on the template. Each mistake below breaks a rule of Fla. Stat. § 765.202 or a term of the template when it applies.

• Signing without both adult witnesses in the room.
• Asking the person you named as your surrogate to be a witness.
• Using only your spouse and a blood relative as witnesses, when at least one witness must be neither.
• Assuming the designation expires on its own, when it remains in effect until you revoke it unless it states a time of termination.
• Forgetting that Part III revokes your earlier health care powers of attorney and living wills.
• Skipping Part II, which states your wishes about end-of-life care and deserves a careful reading.
• Leaving the only copy in a drawer, when it is common practice to give copies to your surrogate and your doctor.

Frequently Asked Questions

How many witnesses does a Florida medical power of attorney need?

The document needs two subscribing adult witnesses, who watch the principal sign, Fla. Stat. § 765.202. Neither witness may be the surrogate.

Can a family member witness a Florida medical power of attorney?

One family member may witness, as long as at least one witness is neither the principal's spouse nor a blood relative, Fla. Stat. § 765.202.

Can my health care surrogate act as a witness?

No. The person designated as surrogate shall not act as witness to the document that names them, Fla. Stat. § 765.202. Ask two other adults to witness.

Does a Florida medical power of attorney need to be notarized?

The signing rule of Fla. Stat. § 765.202 names two subscribing adult witnesses and does not mention a notary. The FormsPal template includes a notary acknowledgment page anyway.

How long does a Florida medical power of attorney last?

Unless the document states a time of termination, the designation remains in effect until the principal revokes it, Fla. Stat. 765.202(7). The FormsPal template states no end date.

Can a medical power of attorney cover a minor child?

A person holding a power of attorney to provide medical consent for a minor may consent to the minor's care only when, after a reasonable attempt, the person with the power to consent cannot be contacted and has given the provider no notice to the contrary, Fla. Stat. § 743.0645(2)(a). The rule covers a minor not committed to, or in the custody of, the Department of Children and Families or the Department of Juvenile Justice under chapter 39, 984 or 985, as that same section, Fla. Stat. § 743.0645(2)(a), states.

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

• Florida Last Will
• Florida Living Will
• Florida Small Estate Affidavit
• Florida Bill of Sale
• Florida Rental Lease Agreement
• Florida Eviction Notice

Create a free high-quality Florida Medical Power of Attorney online now!

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General information, not legal or tax advice.

Sources

Each citation in the text above points to a Florida source listed here. Open the link to read the provision in full, and check the current text and forms before you rely on them.

1. Fla. Stat. § 765.202: who signs and witnesses a surrogate designation, and when it ends.
   • 1.1 Fla. Stat. 765.202(7), duration unless the document states a time of termination
   • 1.2 Fla. Stat. § 765.202, the two subscribing adult witnesses and who may not witness
   • 1.3 Fla. Stat. 765.202(3), an alternate surrogate when the designation is explicit
2. Fla. Stat. § 765.104. Accessed October 15, 2026.
   • 2.1 Fla. Stat. 765.104(1)
3. Fla. Stat. § 765.205. Accessed October 16, 2026.
   • 3.1 Fla. Stat. 765.205(1)(b)
4. Fla. Stat. § 765.113. Accessed October 16, 2026.
   • 4.1 Fla. Stat. 765.113(2)
5. Fla. Stat. § 765.203, suggested form of designation of health care surrogate.
6. Fla. Stat. § 709.2104: when a chapter 709 power of attorney is durable.
7. Fla. Stat. § 709.2105: signing rules that apply only to chapter 709 powers of attorney.
8. Fla. Stat. § 709.2109: when a power of attorney or an agent's authority ends.
9. Fla. Stat. § 743.0645: who may consent to a minor's medical care when the person with the power to consent cannot be contacted.

Mara Erlach

Writer & Attorney

Mara has been practicing estate planning and trust law in California since 2003, taking pride in helping clients of all backgrounds and asset profiles form a complete and customized estate plan. Her specialties are: estate planning, wills and trusts, trust and probate administration.